Potential Renal Acid Load of Foods and its Influence on Urine pH

Remer, Thomas; Manz, Friedrich

doi:10.1016/s0002-8223(95)00219-7

Cited by 627 publications

(669 citation statements)

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“…These findings were corroborated in a similar 30-d bed rest study in which use of an amino acid and carbohydrate supplement was associated with increased bone resorption in subjects who did not perform any exercise [50]. The proposed mechanism for the negative effect of dietary acid loads on bone is related to evidence that bone acts as a reservoir of basic ions to neutralize an acid load [8,18,31,32,51].…”

Section: Introductionmentioning

confidence: 76%

“…The concept of evaluating the ratio of protein and potassium is based on a calculation to estimate net endogenous noncarbonic acid production [15]. Diet can influence endogenous acid production because food contains acid and base precursors (compounds that yield acid or base according to their metabolism post absorption) [32,51]. An acidic metabolic environment has been theorized to stimulate bone resorption.…”

Section: Discussionmentioning

confidence: 99%

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Lower body negative pressure treadmill exercise as a countermeasure for bed rest-induced bone loss in female identical twins

Zwart

Hargens

Lee

et al. 2007

Bone

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Supine weight-bearing exercise within lower body negative pressure (LBNP) alleviates some of the skeletal deconditioning induced by simulated weightlessness in men. We examined the potential beneficial effect in women. Because dietary acid load affected the degree of bone resorption in men during bed rest, we also investigated this variable in women. Subjects were 7 pairs of female identical twins assigned at random to 2 groups, sedentary bed rest (control) or bed rest with supine treadmill exercise within LBNP. Dietary intake was controlled and monitored. Urinary calcium and markers of bone resorption were measured before bed rest (BR) and on BR days 5/6, 12/13, 19/20, and 26/27. Bone mineral content was assessed by dual-energy X-ray absorptiometry before and after bed rest. Data were analyzed by repeated measures two-way analysis of variance. Pearson correlation coefficients were used to define the relationships between diet and markers of bone metabolism, and to estimate heritability of markers. During bed rest, all markers of bone resorption and urinary calcium and phosphorus increased (P < 0.001); parathyroid hormone (P = 0.06), bone-specific alkaline phosphatase (P = 0.06), and 1,25-dihydroxyvitamin D (P = 0.09) tended to decrease. LBNP exercise tended to mitigate bone density loss. The ratio of dietary animal protein to potassium was positively correlated with urinary calcium excretion for all weeks of bed rest in the control group, but only during weeks 1 and 3 for the exercise group. Pre-bed rest data suggested that many markers of bone metabolism have strong genetic determinants. Treadmill exercise within LBNP had less of a protective effect on bone resorption during bed rest in women than previously-published results had Sources of support: This study was funded by NASA through grant NAG 9-1425 and by NIH through grant GCRC M01-RR00827 to UCSD.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. shown for its effect in men, but the same trends were observed for both sexes. Dietary acid load of these female subjects was significantly correlated with calcium excretion but not with other bone resorption markers. NIH Public Access

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Section: Introductionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Lower body negative pressure treadmill exercise as a countermeasure for bed rest-induced bone loss in female identical twins

Zwart

Hargens

Lee

et al. 2007

Bone

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“…Previous studies have demonstrated that ingestion of an alkalinizing agent prevented the calciuria which normally accompanies high protein diets (Lutz, 1984) and that when base is administered at a dose sufficient to neutralize endogenous acid production, calcium balance is improved, bone resorption is reduced, and bone formation is increased (Sebastian et al, 1994). In Western diets meats, cheeses and cereal grains yield high potential renal acid loads (Remer & Manz, 1995) and hence may promote osteoporosis by producing a net metabolic acidosis (Barzel, 1995). In contrast, fruit and vegetables yield a net alkaline renal load (Remer & Manz, 1995), and high fruit and vegetable diets have been shown to improve urinary calcium excretion rates (Appel et al, 1997).…”

Section: Dietary Proteinmentioning

confidence: 99%

“…In Western diets meats, cheeses and cereal grains yield high potential renal acid loads (Remer & Manz, 1995) and hence may promote osteoporosis by producing a net metabolic acidosis (Barzel, 1995). In contrast, fruit and vegetables yield a net alkaline renal load (Remer & Manz, 1995), and high fruit and vegetable diets have been shown to improve urinary calcium excretion rates (Appel et al, 1997). Consequently, in hunter-gatherer populations consuming high protein diets, a concomitant consumption of high levels of fruit and vegetables may have countered the calciuretic effects of a high-protein diet.…”

Section: Dietary Proteinmentioning

confidence: 99%

The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic

et al. 2002

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Objective: Field studies of twentieth century hunter-gathers (HG) showed them to be generally free of the signs and symptoms of cardiovascular disease (CVD). Consequently, the characterization of HG diets may have important implications in designing therapeutic diets that reduce the risk for CVD in Westernized societies. Based upon limited ethnographic data (n ¼ 58 HG societies) and a single quantitative dietary study, it has been commonly inferred that gathered plant foods provided the dominant energy source in HG diets. Method and Results: In this review we have analyzed the 13 known quantitative dietary studies of HG and demonstrate that animal food actually provided the dominant (65%) energy source, while gathered plant foods comprised the remainder (35%). This data is consistent with a more recent, comprehensive review of the entire ethnographic data (n ¼ 229 HG societies) that showed the mean subsistence dependence upon gathered plant foods was 32%, whereas it was 68% for animal foods. Other evidence, including isotopic analyses of Paleolithic hominid collagen tissue, reductions in hominid gut size, low activity levels of certain enzymes, and optimal foraging data all point toward a long history of meat-based diets in our species. Because increasing meat consumption in Western diets is frequently associated with increased risk for CVD mortality, it is seemingly paradoxical that HG societies, who consume the majority of their energy from animal food, have been shown to be relatively free of the signs and symptoms of CVD. Conclusion: The high reliance upon animal-based foods would not have necessarily elicited unfavorable blood lipid profiles because of the hypolipidemic effects of high dietary protein (19 -35% energy) and the relatively low level of dietary carbohydrate (22 -40% energy). Although fat intake (28 -58% energy) would have been similar to or higher than that found in Western diets, it is likely that important qualitative differences in fat intake, including relatively high levels of MUFA and PUFA and a lower o-6=o-3 fatty acid ratio, would have served to inhibit the development of CVD. Other dietary characteristics including high intakes of antioxidants, fiber, vitamins and phytochemicals along with a low salt intake may have operated synergistically with lifestyle characteristics (more exercise, less stress and no smoking) to further deter the development of CVD.

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“…NAE is the summation of net endogenous acid production determined by the dietary intakes of protein and minerals on one hand, and endogenous components on the other. It can be quantified in 24-h urines by titration methods (Remer andManz, 1994, 1995a;Sebastian et al, 2002) and can be estimated by the potential renal acid load (PRAL), reflecting the dietary acidity (Remer and Manz, 1995b; and a body surface area (BSA)-dependent organic acid anion component (OA), reflecting primarily endogenous acids (Manz et al, 1984;Berkemeyer and Remer, 2006). Recently, Maalouf et al (2004) reported an inverse relationship between 24-h urinary pH (24h-UpH) and body weight, the latter taken as an indicator of obesity and peripheral insulin resistance, in patients with nephrolithiasis.…”

Section: Introductionmentioning

confidence: 99%

Muscularity and adiposity in addition to net acid excretion as predictors of 24-h urinary pH in young adults and elderly

Berkemeyer

Rylander

Vormann³

2006

Eur J Clin Nutr

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Objective: In patients with nephrolithiasis, an inverse relationship between 24-h urinary pH (24h-UpH) and body weight has been reported. Whether body composition indices and 24h-UpH are similarly associated in healthy subjects needs investigation. Design: Cross-sectional, retrospective analysis. Setting: Dortmund, Germany and Gothenburg, Sweden. Subjects: Healthy young adults (18-23 years; n ¼ 117) and elderly (55-75years; n ¼ 85) having a mean body mass index (BMI) of 22.8073.4 and 25.373.9 kg/m 2 , respectively. Methods: Anthropometric data, 24h-UpH, and 24-h urinary excretion rates of net acid (NAE), creatinine, and urea were determined. After adjusting for urea (reflecting protein intake), renal creatinine output was used as a biochemical marker for muscularity. The BMI served as a marker of adiposity. Results: NAE, body weight, and BMI were significantly (Po0.05) higher, and height and creatinine significantly lower in the elderly, whereas body-surface area (BSA) was not different.Step-wise multiple regression analysis using BSA-corrected urinary variables revealed NAE as the primary predictor of 24h-UpH (with R 2 values of 0.64 and 0.68 in young adults and elderly, respectively, Po0.0001), followed by urea (Po0.0001), creatinine (Po0.05), and BMI (Po0.05 for the young adults and P ¼ 0.12 for the elderly). These associations were negative for NAE and BMI, and positive for urea and creatinine. Conclusions: Muscularity (i.e. creatinine adjusted for urea) and particularly in the group of young adults, adiposity (i.e. BMI) proved to be modest, but significant predictors of 24h-UpH. Future research should focus on more obese subjects in whom insulin resistance and particular kidney functions should also be examined to further substantiate the role of obesity in low-urine pH-associated conditions, for example, nephrolithiasis.

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Potential Renal Acid Load of Foods and its Influence on Urine pH

Cited by 627 publications

References 16 publications

Lower body negative pressure treadmill exercise as a countermeasure for bed rest-induced bone loss in female identical twins

Lower body negative pressure treadmill exercise as a countermeasure for bed rest-induced bone loss in female identical twins

The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic

Muscularity and adiposity in addition to net acid excretion as predictors of 24-h urinary pH in young adults and elderly

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