Dietary Influence on Body Fluid Acid-Base and Volume Balance: The Deleterious “Norm” Furthers and Cloaks Subclinical Pathophysiology

Abstract

The popular modern diet, characterized by an excess of animal protein and salt but insufficient in fruits, vegetables and water, is a poor fit for human physiological and homeostatic regulatory systems. Sustained net acid and sodium retention, coupled with an insufficient intake of cardiovascular protective potassium-rich foods and hydration in the modern diet can give rise to debilitating chronic organ dysfunction and ultimately, mortality. This holds true, especially in our aging population who are already facing inevitable decline in organ functional reserve. Importantly, in most cases, despite the mismatch and adverse effects to multiple organ systems, plasma electrolyte and acid-base parameters can, on the surface, be maintained within a “normal” reference range, primarily by activating (often maximally activating) compensatory homeostatic mechanisms. These diet-induced effects can thus be clinically silent for decades. Embodied in the chronic corrective homeostatic processes, however, are real risks for multiorgan damage. According to the Dietary Guideline Advisory Committee (DGAC), half of American adults have one or more chronic diseases that are preventable with dietary modification. Here, homeostasis of body fluid acid-base, sodium, potassium and water is examined. Our current dietary habits and their required regulatory adaptation, maladaptation and relevant physiology and pathophysiology are discussed. A framework of dietary modifications to avoid a propensity for maladaptation and thus lowers the risks of common modern diseases (primary prevention) and minimizes the risk of chronic and age-related disease progression (secondary prevention) is emphasized. Although there are other variables at play, a key to restoring the all-important dietary potassium to sodium ratio is greater consumption of vegetables/fruits and adopting salt temperance. Dietary and nutritional optimization is an under-emphasized area of health care that has an enormous potential to temper the epidemics of prevalent chronic diseases in modern society and improve population health.

Distinguishing Low and High Water Consumers—A Paradigm of Disease Risk

“…Although wastes and the products of metabolism contribute to extracellular osmolality (P OSM and S OSM ), dietary energy content (Kcal) accounts for 85% of the variance in ROE. Thus, Panel A supports the concept that renal osmolar load each day is largely influenced by diet [93,101,[126][127][128] and agrees with the dietary modification plan advanced by Amro and colleagues in 2016 (i.e., which led to reduced plasma AVP and a reduced TWI requirement for AVP reduction in kidney disease patients) [128]. In contrast, the correlation between TWI and ROE ( Figure 7, Panel B) is weaker (R 2 = 0.29).…”

“…To the contrary, Allen and colleagues [42] concluded that S Na+ levels in the upper half of the "normal range" should be treated as a clinical risk factor that prompts recommendation for modification of water and salt intake. Their conclusion suggests that not all "normal" laboratory blood values represent a similar risk of chronic disease [93]. Further, if this paradigm of disease risk ( Figure 5) is verified, educational campaigns that are designed to increase water intake in healthy individuals, especially low volume consumers, will become important for modifying drinking habits and lower the risk of chronic diseases in LOW.…”

“…intake. Their conclusion suggests that not all "normal" laboratory blood values represent a similar risk of chronic disease [93]. Further, if this paradigm of disease risk ( Figure 5) is verified, educational campaigns that are designed to increase water intake in healthy individuals, especially low volume consumers, will become important for modifying drinking habits and lower the risk of chronic diseases in LOW.…”

“…To the contrary, Allen and colleagues [42] concluded that SNa+ levels in the upper half of the "normal range" should be treated as a clinical risk factor that prompts recommendation for modification of water and salt The current diet of many adults (e.g., characterized by an excess of animal protein and salt but insufficient in fruits, vegetables and water) does not optimally support human physiological and regulatory systems. Nevertheless, plasma electrolyte and clinical biomarkers can be maintained within a laboratory reference range, primarily by activating (i.e., often maximally) compensatory homeostatic mechanisms, even though an increased risk of multi-organ dysfunction and damage result from such chronic corrective homeostatic activities [93]. This suggests that reliance on laboratory reference ranges (i.e., the statistical prediction interval in which 95% of the population exist) to determine health status can be flawed [91].…”

Epidemiologic Evidence for Association between a High Dietary Acid Load and the Breast Cancer Risk

“…Dietary and nutritional optimization, for example, regarding the achievement of a better dietary potassium/sodium ratio, is still not a highly emphasized area of health care. However, it has a great potential to attenuate the impact of prevalent chronic diseases in modern society (including BC) and improve population health [56]. In light of the implications of dietary acid load, although further studies are needed to confirm the present study's findings, we are convinced that from a medical and ethical viewpoint, it is justified to recommend -as we did one decade ago [57]-certain nutritional changes to women, because in the meantime no adverse side effects are expected to occur.…”