Diet-induced metabolic acidosis

doi:10.1016/j.clnu.2011.03.008

Clinical Nutrition

Volume 30, Issue 4, August 2011, Pages 416-421

https://doi.org/10.1016/j.clnu.2011.03.008 Get rights and content

Summary

The modern Western-type diet is deficient in fruits and vegetables and contains excessive animal products, generating the accumulation of non-metabolizable anions and a lifespan state of overlooked metabolic acidosis, whose magnitude increases progressively with aging due to the physiological decline in kidney function. In response to this state of diet-derived metabolic acidosis, the kidney implements compensating mechanisms aimed to restore the acid-base balance, such as the removal of the non-metabolizable anions, the conservation of citrate, and the enhancement of kidney ammoniagenesis and urinary excretion of ammonium ions. These adaptive processes lower the urine pH and induce an extensive change in urine composition, including hypocitraturia, hypercalciuria, and nitrogen and phosphate wasting. Low urine pH predisposes to uric acid stone formation. Hypocitraturia and hypercalciuria are risk factors for calcium stone disease. Even a very mild degree of metabolic acidosis induces skeletal muscle resistance to the insulin action and dietary acid load may be an important variable in predicting the metabolic abnormalities and the cardiovascular risk of the general population, the overweight and obese persons, and other patient populations including diabetes and chronic kidney failure. High dietary acid load is more likely to result in diabetes and systemic hypertension and may increase the cardiovascular risk. Results of recent observational studies confirm an association between insulin resistance and metabolic acidosis markers, including low serum bicarbonate, high serum anion gap, hypocitraturia, and low urine pH.

Section snippets

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

MA conceived the study and drafted the manuscript. GS participated in its design and helped to revise it. All authors read and approved the final manuscript.

There is no financial support for this work.

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ReviewDiet-induced metabolic acidosis

Summary

Section snippets

Conflicts of interest

Acknowledgments

J Nutr

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

J Nutr

Am J Med

Kidney Int

J Diabetes Complications

Am J Clin Nutr

Metabolism

Lancet

Biomed Pharmacother

Kidney Int

Kidney Int

Am J Kidney Dis

Am J Med

Am J Clin Nutr

The influence of dietary sulfur on the urinary output of acid in man

Clin Sci

Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism

J Clin Endocrinol Metab

Neutralization of Western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans

Am J Physiol Ren Physiol

Partial neutralization of the acidogenic Western diet with potassium citrate increases bone mass in postmenopausal women with osteopenia

J Am Soc Nephrol

Diet, evolution and aging–the pathophysiologic effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet

Eur J Nutr

Relationship between urinary calcium and net acid excretion as determined by dietary protein and potassium: a review

Nephron

Influence of nutrition on acid-base balance–metabolic aspects

Eur J Nutr

Dietary sodium chloride intake independently predicts the degree of hyperchloremic metabolic acidosis in healthy humans consuming a net acid-producing diet

Am J Physiol Ren Physiol

Longitudinal studies on the rate of decline in renal function with age

J Am Geriatr Soc

Urine composition in type 2 diabetes: predisposition to uric acid nephrolithiasis

J Am Soc Nephrol

Low urine pH: a novel feature of the metabolic syndrome

Clin J Am Soc Nephrol

Ammonium chloride metabolic acidosis and the activity of renin-angiotensin-aldosterone system in children

Eur J Pediatr

Chronic metabolic acidosis increases the serum concentration of 1,25-dihydroxyvitamin D in humans by stimulating its production rate. Critical role of acidosis-induced renal hypophosphatemia

J Clin Invest

Differing effects of supplemental KCl and KHCO3: pathophysiological and clinical implications

Semin Nephrol

Review
Diet-induced metabolic acidosis

Differing effects of supplemental KCl and KHCO₃: pathophysiological and clinical implications