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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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May 26, 2014

Dear Mark: Does Dietary Acid/Base Balance Matter?

By Mark Sisson
47 Comments

MeatFor today’s Dear Mark, I’m covering just one topic: the relevance of acid/base balance to health. Anyone wading through the morass of Internet diet information has come across the idea than an excess of acidity derived from our diet overloads the body’s ability to balance it with alkalinity. A diverse group invokes it, including strict paleo dieters, vegans grasping for straws to indict meat, and web sites featuring HTML from the 1990s that sell alkalizing water tablets. And because acidity sounds caustic and vaguely negative, lots of people buy into it. So, does it matter?

Let’s go:

I often hear about the acid-alkaline properties of foods in the comments and forums. However, I am not sure if this has any scientific merit. You don’t seem to have any posts about it so would you care to shed some light on the matter?

Hashim

Human blood likes to have a pH between 7.35 and 7.45, slightly above neutral. If pH dips too low and our blood becomes acidic, our cells stop working. This is called metabolic acidosis, and it comes in two flavors – acute and chronic. Left untreated, acute acidosis will kill you, while chronic acidosis leads to a host of health conditions that will eventually kill you or at least erode your quality of life:

  • Hypothyroidism
  • Muscle wasting
  • Bone loss
  • Glucose intolerance
  • Growth hormone resistance (which can retard growth in kids)

When we metabolize foods and nutrients, some of them produce acids as byproducts. Acid-producing foods include meat, fish, grains, legumes, and dairy. They therefore represent a “high acid load,” and avoiding a high acid load is one of the main reasons many plant-based health types recommend avoiding animal foods. Our bodies, you’ve probably heard, just can’t handle the acidic fallout of all that meat and dairy without falling into metabolic acidosis.

Actually, the body has several ways to maintain the optimal pH range and avoid health problems in the face of acid-forming foods – and they’re extremely effective. If they weren’t, we’d be dead.

One way is through basic respiration – breathing. The lungs monitor the pH of our blood, prompting faster breathing when acidity needs to drop and slower, deeper breathing when acidity needs to rise. By exhaling carbon dioxide, we expel excess acidity. This is the primary way we compensate for fluctuations in pH.

Another way is through the kidneys. When acidity is high, the kidneys excrete more acids and produce bicarbonate, which returns to the blood as a buffering agent. Buffering agents combine with acids in the blood to neutralize them for easier excretion. There are other buffering agents, but bicarbonate is the primary one.

Yes, blood pH is tightly and most importantly unconsciously regulated. As long as your kidneys and lungs are working, the foods you eat will neither lower nor raise the acidity of your blood. What about those urine sticks that measure pH? Altering urinary pH with the food you eat is easy enough, but it doesn’t reflect blood pH. In fact, “acidifying” one’s urine by eating “too much” meat is proof that your kidneys are doing their job and excreting excess acid from the blood.

Thus we invalidate the most drastic claim about pH and health – that an acidic diet promotes acidic blood which promotes cancer. The body’s pH is maintained in a narrow range, regardless of the food you eat. Since its proponents are never able to cite any direct evidence beyond a misinterpreted Otto Warburg quote, I never put much stock in this claim.

But the next claim sounds more plausible: maintaining optimal pH in the face of acid-forming foods requires a calcium buffer that we leach directly from our bones. This leads to osteoporosis and the eventual dissolution of our entire skeletal system until we’re nothing but a disembodied urethra spewing brittle bone paste. Okay, that last part I made up. No one says that (I hope). There is evidence that appears to support the claim, which is why this idea has so much traction. First, consumption of the most acid-forming food of all, protein, does increase calcium excretion in the urine. And second, exposing in vitro bones to a metabolic acidosis test tube environment results in mineral dissolution, calcium loss, and production of the prostaglandins involved in osteoporosis.

Superficially, it’s compelling.

The entire premise falls apart when you look at the actual effects of consuming the most acid-forming food of all – protein – on the bones of real live humans. What happens to your bones when you eat protein? Although eating acid-forming protein often increases urinary calcium, it has an overall beneficial effect on bone metabolism and acid/base balance:

Dietary protein increases intestinal calcium absorption. Maybe it’s because the body “knows” it’s about to consume some bone-destroying acid-forming meat or whatever, but studies consistently show that eating protein also increases the amount of calcium we absorb. This is at least partially due to specific amino acids within the protein. At any rate, with more calcium available to the body, more will be excreted.

Dietary protein has no effect on bone resorption. Bone resorption is the removal of calcium from bone. If acid-forming protein were leaching calcium from your bones, resorption markers should be increasing. They don’t. Studies consistently show that eating protein has no effect on bone resorption.

Dietary protein increases renal function. People with existing renal insufficiency are often advised to lower their protein intake, but in healthy people with normal kidney function, eating sufficient protein is important for maintaining that function. By providing ammonia substrates, protein actually increases the kidney’s capacity to do its job and excrete acids.

The same goes for dairy, another acid-forming food that gets a ton of flack from many online health communities for its supposedly bone-dissolving effects. In truth, dairy is good for bone health. Maybe it’s the phosphate, which has been shown to reduce calcium excretion in the urine and improve calcium balance in the body. Or it could be the vitamin K2, a vital bone nutrient found in whole fat aged cheeses that improves bone mineral density in osteoporotic patients. Maybe it’s the dairy protein, which increases calcium retention and reduces bone calcium resorption while improving bone mineral density. Even when you add acid-forming dairy protein to a diet that’s already replete in acid-forming protein, it has no effect on bone mass or strength. There’s also the calcium to consider, along with the synergy of all the listed nutrients.

So it’s unsurprising that a diet high in meat and other acid-forming foods increases calcium absorption and excretion while lowering parathyroid hormone (a hormone usually elevated in osteoporosis).

If there is a problem with acid load, it’s only in people with renal insufficiency. Outright kidney failure can obviously cause metabolic acidosis, and it’s possible that gradually declining kidney function results in problematic low-level acidity. Kidney function certainly tends to decline with age, while the risk of fractures increases. Despite that weak connection between old age and renal insufficiency, seniors who eat more protein still have better bone calcium retention and absorption.

I’m not arguing that the acid/base balance of our blood isn’t important. It is. I’m arguing that the healthy among us are unable to consciously alter it, whether through the foods we eat or sheer will. And I’m arguing that some of the most acidic foods – meat and dairy – tend to have the most beneficial effects on bone health. Eating a purely acidic diet isn’t a good idea, but that’s because you’d be eliminating a ton of healthy plant matter with important nutrients, not because of the effect it has on your blood acid/base balance.

The weight of the evidence is clear: the acid-load of the diet has no effect on bone health in healthy people.

Thanks for reading, all.

TAGS:  dear mark

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47 Comments on "Dear Mark: Does Dietary Acid/Base Balance Matter?"

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Growing Grok (Hashim)
Growing Grok (Hashim)
2 years 4 months ago

Thanks for the prompt answer! I eat a lot of meat and this question was nagging at me for a while.

Erica
2 years 4 months ago

It’s always amazes me how efficiently our bodies are designed. As you stated, acid/base pH levels are important, but our body does a pretty darn good job regulating it naturally (most of the time and assuming we eat a healthy diet.)

Jonathan Bechtel
2 years 4 months ago
Not only that, but the amount of “alkaline” foods you need to eat to restore pH balance is incredibly small. So even small portions of green foods can raise pH enough to avoid low pH levels. Mark this is a good article except the only part I don’t see mentioned is the link between acidity and cancer. It has slightly more scientific merit than some of the other claims about pH but it’s still mistaken, due to the guy you mentioned in your post: Otto Heinrich Warburg. He showed that cancer causes acidity, not the other way around.
Ben Greenfield
2 years 4 months ago

Once you measure Potential Renal Acid Score and Net Endogenous Acid Production it does indeed appear that the body’s homeostatic mechanisms can “fail” in the presence of a high net acid load diet, contributing to increased risk for chronic disease. Franly, I don’t think we know everything there is to know about pH regulation yet:

http://www.nutrinfo.com/biblioteca/documentos_adicionales/Fagherazzi.pdf

Count.
Count.
2 years 4 months ago

I’m gonna go out on a limb here and speculate that sugar and the insulin response maintain this mystery acidic environment; and prevent the renal ph balancing acts.

Anne
Anne
1 year 7 months ago

Hey Ben, does ketosis (ketoacidosis) cause metabolic acidosis? if so, a low carb ketogentic diet or even fasting make you “too acidic”, right? let me know what you think, thanks!

Groktimus Primal
2 years 4 months ago

It’s funny that everyone who goes about spouting off about balance usually has a very poor definition if any about what that balancing point actually is. The food pyramid (as a balanced diet) turned out to be about as bottom heavy as you can get! Now some folks would have us eat in a way to try to keep our blood levels in the magic PH range that nature takes care of.

Harry Mossman
2 years 4 months ago

Valuable info for me. I am old (71). I have somewhat reduced kidney function. I have diabetes.

Not too long before going Primal, one of my teeth had to be pulled because my body was sucking the calcium out of it. Every time I went to the dentist, he had to replace fillings that had gotten loose. Now my teeth are good. Vitamin D3 or sunshine, vitamin K2, lots of magnesium. Plenty of protein (but lots of veg too.)

Thanks, Mark!

Shary
Shary
2 years 4 months ago
I eat quite a bit of animal protein because I just plain feel better on a higher-protein diet. If I don’t get enough I start to crave it. I increased the amount slightly after going Paleo, but not much more than I was already eating. Although I also eat plenty of veggies, I usually eat modest portions of some form of protein with every meal. It doesn’t need to be a big steak–although that’s good too–but I do feel that something is missing if I don’t have any animal protein on my plate. A brief stint as a vegetarian years… Read more »
Clay
Clay
2 years 4 months ago

When I became a vegetarian 28 years ago I had the opposite reaction. Meat was a drag on my system and gave me heartburn. Getting rid of the meat worked well. But I didn’t give up eggs (I’ve been eating 4-6 per day my whole life). Giving up on eggs and dairy is actually vegan, not vegetarian. I gave up eggs for a couple of weeks just to see what would happen and I, like you when giving up meat, was not a happy camper. Eggs simply make me feel fantastic. Without them I felt a hole on my diet.

Genevieve
Genevieve
2 years 4 months ago

It’s possible you didn’t tolerate the meat well because you have/had low stomach acid and couldn’t digest it properly. I wonder if taking a HCL supplement or simply apple cider vinegar before eating meat could help? I’ve got low stomach acid from using a PPI for a couple of years and when I eat meat without taking acid supplement beforehand, I get gross smelly burps for hours afterward! Not pleasant!

Clay
Clay
2 years 4 months ago
Possibly, but eating vinegar before eating meat to avoid heartburn, when I never even really cared for meat that much in the fist place, is a lot of work. Giving up meat was super easy. I never was into it in the first place. And now, after not eating it for almost 30 years, it really tastes foreign. You don’t know it when you eat it regularly, but meat (not fish though) has a texture that’s very close to rubber bands.The taste is pretty close to rubber bands as well. I didn’t realize how lacking in flavor meat was until… Read more »
Clay
Clay
2 years 4 months ago

Another I noticed when I stopped eating meat was that I actually liked cranberry sauce more than turkey. That I didn’t so much as like ribs as I liked bar-b-q sauce. And what I really liked about hamburgers was the ketchup and mustard. Basically, meat was defined by the condiments I put on them and meat was really just a delivery device for the condiment.

meepster
meepster
2 years 4 months ago

Yeah, same here. I have eaten tons and tons of meat ever since I was a little kid. Tried vegetarianism for a month, and I was constantly hungry and my brain didn’t work right. Paleo felt very very natural for me.

Hao
Hao
2 years 4 months ago

Great article! My boyfriend was recently doing one of those gimmicky cleanses and had taken it upon himself to lecture me about how all the meat I was eating was causing extreme acidity in my system. I just knew there had to be a non-CW explanation for this topic, and here it is!!

Karl
Karl
2 years 4 months ago

Actually, this explanation is pretty much as CW as you can get…

Wenchypoo
Wenchypoo
2 years 4 months ago

You forgot one illness under “chronic acidosis”–gout.

Markus I
Markus I
2 years 4 months ago

What are the most acidic foods? Grains and meat.

What are the most counter-acidic foods? Green veggies and grass.

So what will you make yourself less acidic? Eating more green veggies! And eating less meat and grains of course.

So just give the cows the green veggies instead of grains and they (like humans) and they will not be acidic anymore but neutral.

The difference? You are now able to eat their meat, too. The grassfed, not the grain-fed CAFO meat, of course. Life can be so simple!

Zenmooncow
Zenmooncow
2 years 4 months ago

I guess it’s all those amino and fatty acids , maybe the amino and lipid group are someone protective.

Mel
Mel
2 years 4 months ago

Thanks for covering this! I’ve heard a lot about this stuff in the past, and it always sounded a little hokey to me. I’m really happy to see some intelligent conversation on this topic that makes sense.

dj
dj
2 years 4 months ago

Protein, beyond that which is required, is redundant, cannot be stored and increases the body’s (toxic) nitrogen load. Calorically speaking, even human mother’s milk is only 1.6% protein by the 10th day postpartum. We can easily get by on 2.5-5% of calories from protein assuming macronutrient and micronutrient requirements are met. Excessive protein draws on the body’s calcium and phosphorus stores in order to restore proper pH balance in individual tissues.

Mark S
Mark S
2 years 4 months ago

I’m not sure what your point is. You apparently did not even read the article.

Bo
Bo
2 years 4 months ago

Well, raising ph seem to work out fine as a cancer cure for Vito at phkillscancer.com at least. Wonder why.

wyatt
wyatt
2 years 4 months ago

The blood pH may be 7.0 but the cells could be 6.0 which can supposedly set the stage for cancer. I would like to know more about the science behind that.

Julia
2 years 4 months ago

I figure given that I have replaced all the grains in my diet with veggies even though I eat meat I am probably on more of an alkaline diet than some one that doesn’t eat meat but has a heap of grains. Only eating grains and meat is going to get you into trouble regardless of alkalinity.

PEZ
PEZ
2 years 4 months ago
OMG, this is medschool 101. That you can alter your blood pH, or any pH in your body, by the foods you eat is just plain wrong. Every proper health care professional knows this, whether they are CW or primal. The exception is of course the kidneys and urine, as the kidneys are the organ actually regulation blood pH, hence excess acid or base will be excreted in urine. And yes, other areas of our bodies have different pH-values. They are designed so, as they have different functions. The stomach for example has a pH-value of around 2, because this… Read more »
PracticeBalance
2 years 4 months ago

Amen. As a physician by training, I cringe when I see articles about changing your body’s pH. Blood pH is buffered with a tightly regulated system, unless your kidneys are failing or you have a serious infection, etc.

That being said, I do appreciate Mark’s candor of dispelling the myth without being accusatory of what others say.

Adrian
Adrian
2 years 4 months ago

Hi Mark,

I understand the concept of our Liver and Kidneys removing excess acid so it does not cause an increase in blood acidity. But do we not need to consider the excess stress placed on these organs when our diet is too high in acid?

Can a highly acidic diet lead to lowered organ function and then increased blood acidity?

Luke Terry
2 years 4 months ago

Great article, I appreciate the perspective.

A nutritional instructor in my field raised many of these points, and had a pithy rejoined I’d like to share regarding acid phobia:

What are proteins made of? Amino acids–not amino alkalines.

What are fats made of? Fatty acids. Not fatty alkalines.

If two of the most important and most basic building blocks of life are acids, do you really think that acids can be antithetical to health?

Christina
Christina
2 years 4 months ago

+1

Dylan
Dylan
2 years 4 months ago

Don’t forget nucleic acids!

Craig
2 years 4 months ago

Very clear and concise answer to the question. It has been bugging my for a while, cheers Mark!

C L Deards
2 years 4 months ago

You had me at “…we’d be dead otherwise”

If meat and animal fat were bad for us humans would not be here today.

kip
kip
2 years 4 months ago
Nice artical on acid/base ph level of our blood, and how the body compensates one way or the other depending on the foods we eat. I was a little surprised in your stance that what we eat does not affect our acid/alkaline ph level of our blood. Of course one meal will not throw things off, but a regular diet of the “SAD” has to have an impact on the body’s ph levels, as does a paleo diet. I would be very interested to see if there is any research out there concerning the impact of sugar and grains on… Read more »
tkm
tkm
2 years 4 months ago
The answer to your question is: nothing influences the ph levels. Per Mark in the above article: “I’m not arguing that the acid/base balance of our blood isn’t important. It is. I’m arguing that the healthy among us are unable to consciously alter it, whether through the foods we eat or sheer will.” The point of this article, as I understand it, is that our blood acidity remains constant and is not affected by the foods we eat. So whether it’s grains, mean, alkaline, acidic, primal, SAD, etc. doesn’t matter. The acid/alkaline nutritional philosophy is junk science, and further research… Read more »
Nancy
Nancy
2 years 4 months ago

What about taking all of these different protein shakes, are these good for us, or is it better to eat good meats, dairy and eggs?

jack lea mason
jack lea mason
2 years 4 months ago
One Thing I did not see mentioned is ketoacidosis. This is possible with too much alcohol, protein and type 1 diabetes or any combination of thereof. Dehydration, excessive physical activity and lack of available systemic bicarbonate are often triggers. The breakdown of fatty and amino acids produces more ketone bodies than the body can process thus increasing blood acidity. So yes acid can be a problem but in extreme situations. Type 1 diabetics, gout sufferers and insulin resistant alcoholic weekend warriors need think petite fillet instead of a double end cut and go big on greens if appetite demands a… Read more »
Whitefox
Whitefox
2 years 4 months ago

That’s a nice set of links Mark – ya’ll are missing out on the sodium bicarbonate connection though ala Suppversity:

http://suppversity.blogspot.com/2011/11/baking-soda-for-stressed-white-blood.html
http://suppversity.blogspot.com/2012/09/the-latest-on-sodium-bicarbonate-serial.html

and the Berkemeyer study Dr. Andro cites in that last post: http://www.ncbi.nlm.nih.gov/pubmed/19410381

No idea how that applies to a healthy human, or how you’d figure out if you have “latent acidosis”, but if serial loading of sodium bicarbonate can better your endurance and health, I’d say go for it.

Adora
2 years 4 months ago

Thanks for the article….. its good to eat meat rather protein shake…

Nathan Brammeier
2 years 4 months ago
What a wonderful article. Thank you for posting and thank you, Hashim, for the question. I think what often gets lost is the fact that everyone is unique. Everyone is different. We are ALL different on the outside. Why, in the world, don’t we think we’re different on the inside? We each have a unique biochemical makeup. The body really does an incredible job at regulating pH balance of the blood because, as mentioned, otherwise we’d be dead. Not only do the cells not work properly, but our enzymes need a specific pH level to remain in the same configuration.… Read more »
Natalie
Natalie
2 years 3 months ago

I have a condition called interstitial cystitis/painful bladder syndrome. Metabolic byproducts of the food you eat can affect the pH of your urine. So those of you that might have this condition, it might be worth altering your diet to make your urine more alkaline. Acidic urine can be painful to someone with IC/PBS.

So although this article focuses on the acid/alkaline diet with respect to blood pH, those with IC/PBS might consider changing their diet to alter the pH of their urine.

Chris Kresser has a good article that discusses this issue.
http://chriskresser.com/the-ph-myth-part-1

Sarah Harris
Sarah Harris
2 years 3 months ago
My husband and I just switched from conventional meat to grass-fed beef last week. I’ve always had GERD problems (heartburn and up all night among other things) but I’ve had it under control the last year or so with bouts of severe GERD occurring only once in a blue moon. Since I’ve switched to grass-fed beef, I’ve had heartburn every single time I’ve eaten the beef. I’ve had worse things than beef this week (like pizza) and they aren’t giving me heartburn–it’s obviously the beef. Is there a difference between the conventional and gf that would be causing this problem?… Read more »
Leah
Leah
2 years 3 months ago
This may be true for the *healthy*. I, however, have been suffering from hypothyroidism, reduced bone density, muscle wasting, urinary urgency (caused by the lining of the bladder complaining about low pH), and systemic inflammation (which also causes increased acidity). The kidneys can’t ‘produce’ bicarbonate to buffer the acids unless there is bicarbonate in the diet. While it would clearly be best to get said bicarbonate from plants, Tri-Salts (calcium carbonate, sodium bicarbonate, and potassium bicarbonate) have been working well for me. It’s nice to be able to sleep thru the night without having to get up to pee, be… Read more »
BhaktiBellaLuce
BhaktiBellaLuce
2 years 2 months ago

My question is … anything dietary that may relate to a sudden appearance and reoccurance of vaginal yeast infections? Have not changed ANYTHING except my diet. Too much protein, not enough veggies ? Not enough yogurt ,lol ?
Ideas anyone?

Dina
Dina
2 years 2 months ago
Bhakti, it looks like you have candida (a type of yeast) overgrowth called candidiasis. The yeast infection may have reappeared if you changed your diet to Paleo. If you went Paleo, you may need to reverse your proportion of protein to veggies to reduce acidity. There are differing opinions about what one should and should’t eat on candida treatment and maintenance diets. But I’ve never heard of basing the diet on animal meat. It’s just too acidic and stressful on the digestion for someone with candidiasis. Vaginal yeast infections originate in the gut. Consider changing your diet and taking the… Read more »
Dina
Dina
2 years 2 months ago

Bhakti,

Check out this MDA post AND the comments. You may find commonality with some of the commenters that will lead you to answers for yourself. Good luck!

http://www.marksdailyapple.com/candida/#axzz37YmIi6o0

Dina

Devin
Devin
6 months 29 days ago

I’m a little perplexed. I’m reading “Primal Blueprint” now and there’s mention of the importance of maintaining and “alkaline environment” in regards to moderating dairy. When I came to this passage I started to lose confidence in the author because I know the acid-ash theory is bunk. This article seems to swing in the other direction. Am I reading an out-of-date version of the book or is there some flip-flopping going on? I am enjoying the book and the benefits of working with the information.

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