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Alkaline Diet: Contradictions?

alkaline diet acid foods

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#1 berrycurious

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Posted 18 February 2013 - 12:12 PM


What I've read thus far about this diet--reducing acidic foods in order to reduce the amount of work the body has to do to regulate its levels (by leeching calcium from the bones, etc.) makes sense. But what I don't get is that a lot of the foods one is supposed to avoid in this diet are also very high in antioxidants. Like blueberries, walnuts, prunes, and coffee! Now, what would be better--eat these foods and reap their anti-inflammatory benefits, while also making the body a bit more acidic, or avoid them and have a more alkaline body but miss out on those antioxidants...?

It's all very confusing, those diets.

#2 HaloTeK

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Posted 18 February 2013 - 09:47 PM

I wouldn't worry a lot about what foods are alkaline or acid. As long as you are eating mostly plants and fruits, you will be getting a ton of micronutrients and minerals. Most of the "scare" tactics with acid foods are that you will be melting your bones. As long as you are getting a decent amount of vitamins and minerals from your food you will be ok (just don't eat high protein). Your body has to maintain a tight ph, I have never believed the people who hark the alkaline diet. Our bodies are really intelligent, breathing alone can help keep our ph within the tight range by releasing or holding onto CO2.

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#3 Mind

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Posted 18 February 2013 - 10:13 PM

I think some of the promoters of the alkaline diet have gone too extreme. The theory is interesting, but usually moderation is the key. Coffee, tea, blueberries, and walnuts have a lot of epidemiological research behind them. Our stomach produces HCl because we evolved with a specific diet. Sure, juicing everything into tiny nutrient particles might reduce the need for HCl in the stomach, but not only is that NOT the way we evolved to eat, but it would be pretty boring too. People who enjoy life tend to live longer. None of the record holding super-centenarians maintained a highly alkaline diet, yet they all lived to over 110 years.

I heard some alkaline diet promoter on the radio the other day saying that you should be constantly eating anti-acid tablets all day long in order to maintain an "alkaline state" in your body. I am pretty sure that would be bad for your health.
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#4 Kevnzworld

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Posted 19 February 2013 - 12:49 AM

I think that the goal should be to avoid becoming acidic, by alkalanizing the diet if there is a problem. Having issues with fungal or yeast overgrowth is a sign of acidity. It is thought that cancer thrives in an acidic environment. You can buy PH test strips to test your urine.
People that have issues with elevated glucose are generally also acidic. The easy thing to do is to drink an alkaline bottled water, and or take a mineral supplement. The theory is that your body leeches calcium from your bones in an attempt to regulate your PH. If you reduce sugar and refined carb intake that should help alkalize you.
I agree that you can over think this.

#5 niner

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Posted 19 February 2013 - 02:17 AM

Is there any published scientific research on the whole "alkaline diet" thing? It sounds flaky. Eating antacids all day is nuts, and is a good way to hurt yourself.
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#6 berrycurious

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Posted 19 February 2013 - 03:41 AM

For those of you who DON'T thinks it's bullshit, what do you think about the contradiction of high antioxidant superfoods not being allowed in the alkaline diet?
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#7 misterE

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Posted 19 February 2013 - 06:05 AM

The most acidic foods are foods high in sulfur-containing amino-acids, like cystine and methionine, which are then metabolized into sulfuric-acid (ouch)! Excess sulfur (found primarily in animal-protein) is also the main cause of bad-breath, stinky farts and BM’s (no joke).

Anyway, a study done by Remer et al in 1995, looked at common foods and their "acid load" in the body [1]. The results of the study are below.

Acid load of common food:
Cheddar-cheese (10)
Fish (9.3)
Chicken (7)
Beef (6.3)
Beans (1)
Wheat-flour (1)
Potato (-5)
Banana (-6)
Tomatoe (-18)
Spinach (-56)


**A positive value indicates acid, a negative value indicates alkaline.


So to solve your dilemma… and to save your bones from osteoporosis while getting enough phytonutrients, I would suggest to lay off the meat and cheese, and load up on potatoes and leafy-greens!



[1] J Am Diet Assoc. 1995 Jul;95(7):791-7. Potential renal acid load of foods and its influence on urine pH. Remer T.

Edited by misterE, 19 February 2013 - 06:07 AM.

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#8 misterE

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Posted 19 February 2013 - 06:20 AM

Is there any published scientific research on the whole "alkaline diet" thing?



Actually there is quite a bit of research done on the acid/alkaline nature of foods and its effects of calcium-balance. Foods that are acidic (like meat and cheese) decrease calcium-balance (which means more calcium is excreted thru the kidneys and urine than is consumed) and promotes osteoporosis and kidney-stones. Worldwide, cultures who eat less animal-protein (which is high in sulfur containing amino-acids, which are then metabolized into sulfuric-acid) have less hip-fractures (the hallmark sign of osteoporosis) than cultures that do eat lots of animal-protein (like the USA and UK).

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#9 ta5

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Posted 19 February 2013 - 02:33 PM

The most acidic foods are foods high in sulfur-containing amino-acids, like cystine and methionine, which are then metabolized into sulfuric-acid (ouch)!


I wonder if MSM will increase sulfuric acid?

#10 platypus

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Posted 19 February 2013 - 02:59 PM

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Correlation does not imply causation. There's a also clear relationship between fractures and latitude, which could be taken as an indicator of vit.D status.
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#11 Kevnzworld

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Posted 19 February 2013 - 04:53 PM

This book offers a pretty good explanation of the alkaline diet, and why it's necessary if one is overly acidic.
It's available to read free online in google books.
http://books.google....bC1TfP648Q9apwA

#12 niner

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Posted 20 February 2013 - 01:44 AM

cystine and methionine, which are then metabolized into sulfuric-acid (ouch)!


Are you sure about this? I looked at a review paper on sulfur-containing AAs, and saw no such thing. Any refs?
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#13 misterE

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Posted 20 February 2013 - 11:05 PM

Are you sure about this? I looked at a review paper on sulfur-containing AAs, and saw no such thing. Any refs?




J Anim Sci. 1990 Feb;68(2):398-408.

A review of the role of acid-base balance in amino acid nutrition.

Patience JF.

Abstract

Acid-base balance and amino acid metabolism are intimately related. Changes in acid-base balance influence the metabolic fate of many amino acids. Also, acid-base homeostasis is achieved in part by alteration of amino acid metabolism, not only in the kidney, but also in liver, muscle and splanchnic tissue. Glutamine is the primary amino acid involved in renal ammonia-genesis, a process intimately related to acid excretion. The metabolism of other amino acids, such a serine, glycine and the branched-chain amino acids, also appears to be influenced by acid-base balance. Conversely, the metabolic fate of various amino acids will influence the daily acid load experienced by the animal. Oxidation of amino acids contributes to the total acid and base load imposed on the pig. The basic (cationic) amino acids (lysine, arginine and histidine) yield neutral end-products plus a proton; sulfur (methionine and cysteine) amino acids are also acidogenic because they generate sulfuric acid when oxidized. The dicarboxylic (anionic) amino acids (aspartate and glutamate, but not asparagine and glutamine) consume acid when oxidized and thus reduce the acid load of the diet. Acid-base balance and related phenomena are discussed in the context of practical and metabolic aspects of amino acid nutrition.

Edited by misterE, 20 February 2013 - 11:07 PM.

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#14 niner

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Posted 21 February 2013 - 02:41 AM

Are you sure about this? I looked at a review paper on sulfur-containing AAs, and saw no such thing. Any refs?


J Anim Sci. 1990 Feb;68(2):398-408.

sulfur (methionine and cysteine) amino acids are also acidogenic because they generate sulfuric acid when oxidized.


That doesn't sound right. I looked in my old biochemistry textbook (Stryer, 2nd ed. p. 416) in the chapter on Amino Acid Degradation, and it says:

Cysteine can be converted into pyruvate by several pathways, with its sufur atom emerging in H2S, SO32-, or SCN-


None of those are "sulfuric acid". SO32- is the sulfite anion, not sulfuric acid. There may certainly be some protons formed in the metabolism of sulfur amino acid, but there is no "ouch", and it doesn't look like there are any scary chemicals being formed. In the Anim. Sci. paper, Patience makes the claim that sulfuric acid is formed, but is there any evidence put forth for the claim?
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#15 misterE

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Posted 22 February 2013 - 01:48 AM

J Appl Physiol. 2005 Jul;99(1):134-40.

Amino acid supplementation alters bone metabolism during simulated weightlessness.

Zwart SR, Davis-Street JE, Paddon-Jones D.

Abstract

High-protein and acidogenic diets induce hypercalciuria. Foods or supplements with excess sulfur-containing amino acids increase endogenous sulfuric acid production and therefore have the potential to increase calcium excretion and alter bone metabolism. In this study, effects of an amino acid/carbohydrate supplement on bone resorption were examined during bed rest. Thirteen subjects were divided at random into two groups: a control group (Con, n = 6) and an amino acid-supplemented group (AA, n = 7) who consumed an extra 49.5 g essential amino acids and 90 g carbohydrate per day for 28 days. Urine was collected for n-telopeptide (NTX), deoxypyridinoline (DPD), calcium, and pH determinations. Bone mineral content was determined and potential renal acid load was calculated. Bone-specific alkaline phosphatase was measured in serum samples collected on day 1 (immediately before bed rest) and on day 28. Potential renal acid load was higher in the AA group than in the Con group during bed rest (P < 0.05). For all subjects, during bed rest urinary NTX and DPD concentrations were greater than pre-bed rest levels (P < 0.05). Urinary NTX and DPD tended to be higher in the AA group (P = 0.073 and P = 0.056, respectively). During bed rest, urinary calcium was greater than baseline levels (P < 0.05) in the AA group but not the Con group. Total bone mineral content was lower after bed rest than before bed rest in the AA group but not the Con group (P < 0.05). During bed rest, urinary pH decreased (P < 0.05), and it was lower in the AA group than the Con group. These data suggest that bone resorption increased, without changes in bone formation, in the AA group.

http://jap.physiolog...4.full.pdf html
















Am J Clin Nutr. 1998 Sep;68(3):576-83.

Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents.

Frassetto LA, Todd KM, Morris RC Jr, Sebastian A.

Abstract

Normal adult humans eating Western diets have chronic, low-grade metabolic acidosis, the severity of which is determined in part by the net rate of endogenous noncarbonic acid production (NEAP), which varies with diet. To prevent or reverse age-related sequelae of such diet-dependent acidosis (eg, bone and muscle loss), methods are needed for estimating and regulating NEAP. Because NEAP is difficult to measure directly, we sought a simple method to estimate it from diet-composition data. We focused on protein and potassium contents because the production of sulfuric acid from protein metabolism and bicarbonate from dietary potassium salts of organic acids are the major variable components of NEAP. Using steady state renal net acid excretion (RNAE) as an index of NEAP in 141 normal subjects eating 20 different diets, we found by multiple linear regression analysis that RNAE [mEq/d x 10460 kJ diet (mEq/d 2500 kcal)] was predictable (R2 = 0.62) from protein [g/d x 10460 kJ diet (g/d 2500 kcal); positive regression coefficient, P < 0.001] and potassium [mEq/d x 10460 kJ diet (mEq/d x 2500 kcal): negative regression coefficient, P = 0.001] contents, which were not themselves correlated. Among diets, 71% of the variation in RNAE could be accounted for by the ratio of protein (Pro) to potassium (K) content: RNAE = 62Pro/K - 17.9 (r = 0.84, R2 = 0.71, P < 0.001). Thus, by considering both the acidifying effect of protein and the alkalinizing effect of potassium (organic anions), NEAP can be predicted with confidence from the readily available contents of only 2 nutrients in foods. Provisionally, these findings allow estimation and regulation of NEAP through diet modification.

http://ajcn.nutritio.../3/576.full.pdf

Edited by misterE, 22 February 2013 - 01:49 AM.

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#16 niner

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Posted 22 February 2013 - 03:55 AM

Zwart SR, Davis-Street JE, Paddon-Jones D.
excess sulfur-containing amino acids increase endogenous sulfuric acid production and therefore have the potential to increase calcium excretion and alter bone metabolism.

Am J Clin Nutr. 1998 Sep;68(3):576-83.
Frassetto LA, Todd KM, Morris RC Jr, Sebastian A.
the production of sulfuric acid from protein metabolism and bicarbonate from dietary potassium salts of organic acids are the major variable components of NEAP.


OK, it's common to describe the overall process as "production of sulfuric acid", but that's a convenient shorthand; it isn't what really happens. Each mole of sulfur ultimately results in (more or less) two equivalents of H+ and one mole of sulfate. However, at no point is there ever any sulfuric acid. Here's what really happens:

Cysteine is oxidized to cysteine sulfinic acid, (pK = 2.1),
thus generating the first equivalent of hydrogen.
Following deamination or transamination of cysteine
sulfinate to beta-sulfinyl pyruvate, a second
equivalent of hydrogen is produced by the hydrolysis
of the beta-sulfinyl pyruvate to acid sulfite
(pK2 = 5.2) and pyruvate. The final oxidation of
sulfite to sulfate does not yield additional acid.


I wouldn't have bothered chasing this issue back to a 1959 paper if you hadn't added the "ouch" for emotional effect. If you want to be taken more seriously in this forum, you should try to refrain from making every single post an attempt to convert us to veganism. You should stick to the science, and don't use emotionally freighted words (like turning blood to "sludge"). It would also help your cause if you used an icon that didn't look like a person suffering from a dietary deficiency.
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#17 misterE

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Posted 22 February 2013 - 05:51 PM

{1} If you want to be taken more seriously in this forum, you should try to refrain from making every single post an attempt to convert us to veganism. You should stick to the science, and don't use emotionally freighted words (like turning blood to "sludge").

{2} It would also help your cause if you used an icon that didn't look like a person suffering from a dietary deficiency.



{1} I'm not trying to convert people to veganism (per say). I'm sticking with what the majority of the scientific-literature suggests: Diets high in fat, sugar and meat is harmful and that diets high in whole-grains, vegetables and fiber are protective.
Surely you are not trying to convince anyone that I haven't been sticking with the science; everything I claim I back up with scientific-studies and anyone who is familiar with my posts knows that I always stick with the science. It's the people who claim high-fat/low-carb diets are healthy, who aren't sticking with what the science says and what epidemiological studies prove.


I've shown you the references you asked for in regards to sulfuric-acid and its effects on bone metabolism. I even was kind enough to link the PDF's so you can read the entire study and see the literature cited in there as well (instead of referring only to a 1950’s paper). Methionine and cysteine do metabolize into harmful components which harm the bones, beside sulfuric-acid, another one being homocysteine. The research done looking at the effects of dietary-protein in the pathogenesis of metabolic-acidosis and osteoporosis is solid, and good science is always backed by epidemiological observations. As I posted above, nations who eat the most meat and cheese (and therefore more dietary-acid) have the highest rates of osteoporosis compared to nations who eat more grains and vegetables.

The research is solid: too much protein and not enough vegetables causes metabolic-acidosis which results in osteoporosis.


{2} My profile picture is a picture of Riff Raff from Rocky Horror Picture Show thank you very much. I'm planning on changing it since low-life’s keep insulting the image.

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Edited by misterE, 22 February 2013 - 05:55 PM.

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#18 kismet

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Posted 03 April 2013 - 09:13 PM

Wow, has it been so long since I last commented on the issue? (http://www.longecity...alues-of-foods/)

The dispute seems still unresolved from what I've gathered in my "5 minute review of the evidence".


A causal association between dietary acid load and osteoporotic bone disease is not supported by evidence and there is no evidence that an alkaline diet is protective of bone health.

Nutr J. 2011 Apr 30;10:41. doi: 10.1186/1475-2891-10-41.
Causal assessment of dietary acid load and bone disease: a systematic review & meta-analysis applying Hill's epidemiologic criteria for causality.
Fenton TR, Tough SC, Lyon AW, Eliasziw M, Hanley DA.
http://www.nutrition...content/10/1/41
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#19 DR01D

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Posted 03 April 2013 - 10:56 PM

I heard some alkaline diet promoter on the radio the other day saying that you should be constantly eating anti-acid tablets all day long in order to maintain an "alkaline state" in your body.


Whoever said that was irresponsible.

Anti-acids are known to reduce the absorption of vitamins including B12 and other nutrients.

Do Antacids Deplete Vitamin B?

The body requires stomach acid to absorb vitamin B-12. Taking antacids neutralizes stomach acid and this affects vitamin B-12 absorption.


Taking anti-acids (unless you are sick and need them) is pure craziness. But... there are a lot of crazy people out there so I guess this concept fills a niche for some people.

Edited by DR01D, 03 April 2013 - 10:59 PM.

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#20 alecnevsky

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Posted 05 April 2013 - 01:37 AM

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Correlation does not imply causation. There's a also clear relationship between fractures and latitude, which could be taken as an indicator of vit.D status.


They also drink more milk than most countries which should presumably mitigate the effects of osteoporosis (via increased calcium) but does not? Or maybe they do it as a result of the high animal protein diet ?

#21 misterE

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Posted 05 April 2013 - 02:11 AM

They also drink more milk than most countries which should presumably mitigate the effects of osteoporosis (via increased calcium) but does not? Or maybe they do it as a result of the high animal protein diet ?




Exactly. Nations who consume the most calcium also have the most osteoporosis! This proves that calcium intake has little or nothing to do with bone health. My personal belief is that these western-countries with high rates of osteoporosis, eat more animal-protein (which is acidic) and animal-fat (which causes insulin/IGF-1 resistance). Insulin and IGF-1 are the main anabolic hormones that build bone mass and maintain the skelton. Eating more (saturated) fat causes insulin and IGF-1 to act abnormally, therefore these hormones are not able to build bone like they normally should. Eating a low-fat diet high in plant-protein will increase the potency of insulin and IGF-1 and also increase calcium balance (by decreasing metabolic-acidosis).

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Edited by misterE, 05 April 2013 - 02:13 AM.


#22 alecnevsky

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Posted 05 April 2013 - 02:28 AM

They also drink more milk than most countries which should presumably mitigate the effects of osteoporosis (via increased calcium) but does not? Or maybe they do it as a result of the high animal protein diet ?




Exactly. Nations who consume the most calcium also have the most osteoporosis! This proves that calcium intake has little or nothing to do with bone health. My personal belief is that these western-countries with high rates of osteoporosis, eat more animal-protein (which is acidic) and animal-fat (which causes insulin/IGF-1 resistance). Insulin and IGF-1 are the main anabolic hormones that build bone mass and maintain the skelton. Eating more (saturated) fat causes insulin and IGF-1 to act abnormally, therefore these hormones are not able to build bone like they normally should. Eating a low-fat diet high in plant-protein will increase the potency of insulin and IGF-1 and also increase calcium balance (by decreasing metabolic-acidosis).

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Lol @ "Incontestable evidence." But yeah the Rs are virtually the same. It doesn't prove anything but the question remains. Maybe we should look at Finland since they're megadosing milk and still not breaking their hips.

#23 ta5

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Posted 05 April 2013 - 05:12 AM

I've been reading a lot of studies on this recently.

Low protein + low calcium = the worst for bones (bones need both protein and calcium)
High protein + low calcium = bad for bone (protein increases need for calcium somehow, some evidence that it's not acid load - but, either way it's bad)
Low protein + high calcium = bad for bones (bones need protein not just calcium)
High protein + high calcium = best for bones

You can debate what "high" and "low" is. And, bones need lots of other things too, but this is just looking at 2 things.
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#24 Luminosity

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Posted 05 April 2013 - 05:56 AM

I don't think it's bullshit. I'm fifty and this has become an issue for me, with my teeth and joints deteriorating, due to excess acids. However, the biggest reason for this was environmental toxins and acids produced by my own body due to stress, rather than diet. Other than that, what I regret most in this regard was drinking a lot of diet coke and going on the old school Atkins diet (mostly animal protein) when I was a teenager. I also drank more diet coke on and off throughout my twenties and thirties, but not the twelve a day I sometimes drank as a teenager on the Atkins diet.

If you eat a healthy diet, what you would likely have to watch out for would be too many acidic fruits and fruit juices, too much vitamin C (especially megadoses), salad dressings and anything else notably acidic. Watch out for energy drinks, fruit juices and smoothies containing citric acid, and really, anything containing citric acid. Some liquid supplements have it. Sometimes malic acid is used in health food drinks instead. It's bad too. Something like Crystal Geyser would be something to watch out for as would be Emergen-C supplements.

So, a common sense approach would be eat less of the most acidic fruits and juices, and minimize the other things on the list. Adding something alkaline or fatty could help. Eat a piece of cheese with an apple. Use a splash of olive oil instead of salad dressing. I think that people used to finish a meal with a piece of cheese for this reason. Have some whole milk yogurt or cream with the berries if it agrees with you. Coconut milk is an alternative. I don't think walnuts and some of the other things you mentioned are a problem.

Try to protect your teeth from acids. Those exposures add up over time. Don't drink liquid vitamin C unless it is buffered or Ester C. Don't take acidic supplements as liquids. Work around that. If you need a liquid supplement, mix one from powder and take it unflavored. Typically the citric acid would be a flavoring and preservative. Use straws. Don't put lemon in your water. Don't put lemons on a lot of stuff. Don't go on a lemon juice-maple syrup cleanse. Try to minimize sodas, even health food sodas. Only take coffee, tea or acidic fruits juices occasionally and rinse your mouth with water afterwards. Consider a homemade restorative mouthwash like green tea or liquid silica after drinking acidic substances. If you brush your teeth directly after consuming acidic food or drink, your teeth may be weakened by the acids and you may be brushing the enamel away.

Eat plenty of vegetables and less acidic fruits. Eat plenty of healthy fats and bioavailable calcium. Eat a steamed green vegetable every day. That will build up the tissues the acids wash away.

About forty you should start supplementing with things that will build up your joints, teeth and bones. I've written a lot here about type II collagen, MSM and silica. You can google for those posts if you want to.

For now, a good vitamin D would help maintain your bones and teeth. I like Source Naturals D3, 2,000 i.u. per day taken with a meal containing fats or oils.

I think you can do a lot with common sense and not have to worry about every food that contains any acid at all.

Edited by Luminosity, 05 April 2013 - 06:08 AM.


#25 berrycurious

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Posted 05 April 2013 - 06:25 AM

@luminosity:

I suggest buying one of those fancy reusable straws and drink both lemonade and coffee from it to minimise harm done by acids on your teeth.

Lemon actually is considered alkaline in the end; its ash is alkaline. Ash is what's left behind inside your body.

Wow, you people on this site are so amazingly knowledgeable.

#26 Luminosity

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Posted 05 April 2013 - 06:34 AM

Where do you buy those straws? Are they glass? I want to buy one.

Straws help, but unless you put it quite a bit down your throat, which no one does, some of that stuff will get on your teeth.

I've heard that about lemons being alkaline, etc. Trust me, it's acidic to your teeth. Personally things that are acidic just seem acidic to my body in spite of those theories. We don't eat ashes.

Edited by Luminosity, 05 April 2013 - 06:52 AM.


#27 berrycurious

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Posted 05 April 2013 - 06:42 AM

I got mine from Glass Dharma. They're made of the most durable type of glass and have a lifetime warranty. Around $14 for one, kind of silly but I use it every day.

#28 misterE

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Posted 05 April 2013 - 08:39 PM

http://www.vivalis.s...toteke/3a00.pdf

J Gerontol A Biol Sci Med Sci. 2000 Oct;55(10):M585-92.

Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods.

Frassetto LA, Todd KM, Morris RC Jr, Sebastian A.

Abstract

BACKGROUND:
Hip fracture, a major health problem in elderly persons, varies in incidence among the populations of different countries and is directly related to animal protein intake, a finding that suggests that bone integrity is compromised by endogenous acid production consequent to the metabolism of animal proteins. If that is so, vegetable foods might provide a countervailing effect, because they are a rich source of base (bicarbonate) in the form of metabolizable organic anions, which can neutralize protein-derived acid and supply substrate (carbonate) for bone formation.

METHODS:
We analyzed reported hip fracture incidence (HFI) data among countries (N = 33) in women aged 50 years and older, in relation to corresponding country-specific data on per capita consumption of vegetable and animal foods as reported by the United Nations Food and Agriculture Organization.

RESULTS:
HFI varied directly with total (r = +.67, p < .001) and animal (r = +.82, p < .001) protein intake and inversely with vegetable protein intake (r = .37, p < .04). The countries in the lowest tertile of HFI (n = 11) had the lowest animal protein consumption, and invariably, vegetable protein (VP) consumption exceeded the country's corresponding intake of animal protein (AP): VP/AP > 1.0. By contrast, among the countries in the highest tertile of HFI, animal protein intake exceeded vegetable protein intake in nearly every case (10 of 11 countries). Among all countries, HFI correlated inversely and exponentially with the ratio of vegetable/animal protein intake (r = -.84, p < .001) and accounted for 70% of the total variation in HFI. Adjusted for total protein intake, vegetable food consumption was an independent negative predictor of HFI. All findings were similar for the subset of 23 countries whose populations are predominantly Caucasian.

CONCLUSION:
The findings suggest that the critical determinant of hip fracture risk in relation to the acid-base effects of diet is the net load of acid in the diet, when the intake of both acid and base precursors is considered. Moderation of animal food consumption and an increased ratio of vegetable/animal food consumption may confer a protective effect.


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#29 ta5

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Posted 06 April 2013 - 12:14 AM


J Bone Miner Res. 2009 Nov;24(11):1835-40.
Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance.
Source
Alberta Health Services, Calgary, Alberta, Canada. tanisfenton@shaw.ca
Abstract
The acid-ash hypothesis posits that protein and grain foods, with a low potassium intake, produce a diet acid load, net acid excretion (NAE), increased urine calcium, and release of calcium from the skeleton, leading to osteoporosis. The objectives of this meta-analysis were to assess the effect of changes in NAE, by manipulation of healthy adult subjects' acid-base intakes, on urine calcium, calcium balance, and a marker of bone metabolism, N-telopeptides. This meta-analysis was limited to studies that used superior methodological quality for the study of calcium metabolism. We systematically searched the literature and included studies if subjects were randomized to the interventions and followed the recommendations of the Institute of Medicine's Panel on Calcium and Related Nutrients for calcium studies. Five of 16 studies met the inclusion criteria. The studies altered the amount and/or type of protein. Despite a significant linear relationship between an increase in NAE and urinary calcium (p < 0.0001), there was no relationship between a change of NAE and a change of calcium balance (p = 0.38; power = 94%). There was no relationship between a change of NAE and a change in the marker of bone metabolism, N-telopeptides (p = 0.95). In conclusion, this meta-analysis does not support the concept that the calciuria associated with higher NAE reflects a net loss of whole body calcium. There is no evidence from superior quality balance studies that increasing the diet acid load promotes skeletal bone mineral loss or osteoporosis. Changes of urine calcium do not accurately represent calcium balance. Promotion of the "alkaline diet" to prevent calcium loss is not justified.
PMID: 19419322


Curr Opin Clin Nutr Metab Care. 2010 Nov;13(6):698-702.
Acid diet (high-meat protein) effects on calcium metabolism and bone health.
Source
USDA, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, North Dakota, USA.
Abstract
PURPOSE OF REVIEW:
Update recent advancements regarding the effect of high-animal protein intakes on calcium utilization and bone health.
RECENT FINDINGS:
Increased potential renal acid load resulting from a high protein (intake above the current Recommended Dietary Allowance of 0.8 g protein/kg body weight) intake has been closely associated with increased urinary calcium excretion. However, recent findings do not support the assumption that bone is lost to provide the extra calcium found in urine. Neither whole body calcium balance is, nor are bone status indicators, negatively affected by the increased acid load. Contrary to the supposed detrimental effect of protein, the majority of epidemiological studies have shown that long-term high-protein intake increases bone mineral density and reduces bone fracture incidence. The beneficial effects of protein such as increasing intestinal calcium absorption and circulating IGF-I whereas lowering serum parathyroid hormone sufficiently offset any negative effects of the acid load of protein on bone health.
SUMMARY:
On the basis of recent findings, consuming protein (including that from meat) higher than current Recommended Dietary Allowance for protein is beneficial to calcium utilization and bone health, especially in the elderly. A high-protein diet with adequate calcium and fruits and vegetables is important for bone health and osteoporosis prevention.
PMID: 20717017


Nutr J. 2011 Apr 30;10:41.
Causal assessment of dietary acid load and bone disease: a systematic review & meta-analysis applying Hill's epidemiologic criteria for causality.
Source
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Abstract
BACKGROUND:
Modern diets have been suggested to increase systemic acid load and net acid excretion. In response, alkaline diets and products are marketed to avoid or counteract this acid, help the body regulate its pH to prevent and cure disease. The objective of this systematic review was to evaluate causal relationships between dietary acid load and osteoporosis using Hill's criteria.
METHODS:
Systematic review and meta-analysis. We systematically searched published literature for randomized intervention trials, prospective cohort studies, and meta-analyses of the acid-ash or acid-base diet hypothesis with bone-related outcomes, in which the diet acid load was altered, or an alkaline diet or alkaline salts were provided, to healthy human adults. Cellular mechanism studies were also systematically examined.
RESULTS:
Fifty-five of 238 studies met the inclusion criteria: 22 randomized interventions, 2 meta-analyses, and 11 prospective observational studies of bone health outcomes including: urine calcium excretion, calcium balance or retention, changes of bone mineral density, or fractures, among healthy adults in which acid and/or alkaline intakes were manipulated or observed through foods or supplements; and 19 in vitro cell studies which examined the hypothesized mechanism. Urine calcium excretion rates were consistent with osteoporosis development; however calcium balance studies did not demonstrate loss of whole body calcium with higher net acid excretion. Several weaknesses regarding the acid-ash hypothesis were uncovered: No intervention studies provided direct evidence of osteoporosis progression (fragility fractures, or bone strength as measured using biopsy). The supporting prospective cohort studies were not controlled regarding important osteoporosis risk factors including: weight loss during follow-up, family history of osteoporosis, baseline bone mineral density, and estrogen status. No study revealed a biologic mechanism functioning at physiological pH. Finally, randomized studies did not provide evidence for an adverse role of phosphate, milk, and grain foods in osteoporosis.
CONCLUSIONS:
A causal association between dietary acid load and osteoporotic bone disease is not supported by evidence and there is no evidence that an alkaline diet is protective of bone health.
PMID: 21529374


Br J Nutr. 2013 Apr 4:1-10.
Nutritional disturbance in acid-base balance and osteoporosis: a hypothesis that disregards the essential homeostatic role of the kidney.
Source
Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland.
Abstract
The nutritional acid load hypothesis of osteoporosis is reviewed from its historical origin to most recent studies with particular attention to the essential but overlooked role of the kidney in acid-base homeostasis. This hypothesis posits that foods associated with an increased urinary acid excretion are deleterious for the skeleton, leading to osteoporosis and enhanced fragility fracture risk. Conversely, foods generating neutral or alkaline urine would favour bone growth and Ca balance, prevent bone loss and reduce osteoporotic fracture risk. This theory currently influences nutrition research, dietary recommendations and the marketing of alkaline salt products or medications meant to optimise bone health and prevent osteoporosis. It stemmed from classic investigations in patients suffering from chronic kidney diseases (CKD) conducted in the 1960s. Accordingly, in CKD, bone mineral mobilisation would serve as a buffer system to acid accumulation. This interpretation was later questioned on both theoretical and experimental grounds. Notwithstanding this questionable role of bone mineral in systemic acid-base equilibrium, not only in CKD but even more in the absence of renal impairment, it is postulated that, in healthy individuals, foods, particularly those containing animal protein, would induce 'latent' acidosis and result, in the long run, in osteoporosis. Thus, a questionable interpretation of data from patients with CKD and the subsequent extrapolation to healthy subjects converted a hypothesis into nutritional recommendations for the prevention of osteoporosis. In a historical perspective, the present review dissects out speculation from experimental facts and emphasises the essential role of the renal tubule in systemic acid-base and Ca homeostasis.
PMID: 23551968

Edited by ta5, 06 April 2013 - 12:43 AM.

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#30 ta5

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Posted 06 April 2013 - 12:42 AM

To save space, I edited out all the text except the parts I liked. You can read the whole abstract on pubmed.


Am J Clin Nutr. 1999 Jan;69(1):147-52.

Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women.

...risk of hip fracture was not related to intake of calcium or vitamin D, but was negatively associated with total protein intake. Animal rather than vegetable sources of protein appeared to account for this association....

Intake of dietary protein, especially from animal sources, may be associated with a reduced incidence of hip fractures in postmenopausal women.

PMID: 9925137


Nutr Rev. 2002 Oct;60(10 Pt 1):337-41.

Elderly women need dietary protein to maintain bone mass.

Excess dietary protein is considered a risk factor for osteoporosis owing to the potential for renal acid load. Researchers who conducted a recent prospective study of older adults reported that animal protein had a protective role for bone, especially in elderly women, whereas plant protein was negatively associated with bone mineral density. An interaction between protein and calcium suggested protein alone was not the important factor. Other studies confirm the beneficial effect of increasing dietary protein intake in older women to reduce bone mineral density loss and risk of fracture, suggesting that emphasis should be placed on promoting adequate protein intake in elderly women.

PMID: 12392151


Can J Diet Pract Res. 2003 Spring;64(1):5-11.

Protein and bone health: literature review and counselling implications.

...There is general agreement in the literature that higher protein intake increases urinary calcium loss; the body compensates for this loss by increasing calcium absorption in the gut, providing that calcium intake is sufficient. ...

PMID: 12631403


J Nutr. 2003 Mar;133(3):855S-861S.

Low protein intake: the impact on calcium and bone homeostasis in humans.

...there are no definitive nutrition intervention studies that show a detrimental effect of a high protein diet on the skeleton ... Several recent epidemiological studies demonstrate reduced bone density and increased rates of bone loss in individuals habitually consuming low protein diets...

PMID: 12612169


Proc Nutr Soc. 2003 May;62(2):505-9.

Calcium and protein in bone health.

... In a recent study it was found that increasing dietary protein was associated with a favourable (positive) change in bone mineral density of the femoral neck and total body in subjects taking supplemental calcium citrate malate with vitamin D, but not in those taking placebo....

PMID: 14506898


J Nutr. 2003 Mar;133(3):852S-854S.

Interaction of dietary calcium and protein in bone health in humans.

Protein has both positive and negative effects on calcium balance, and the net effect of dietary protein on bone mass and fracture risk may be dependent on the dietary calcium intake. In addition to providing substrate for bone matrix, dietary protein stimulates the production of insulin-like growth factor-1 (IGF-1), a factor that promotes osteoblast-mediated bone formation. Protein also increases urinary calcium losses, by several proposed mechanisms. Increasing calcium intake may offset the negative impact of dietary protein on urinary calcium losses, allowing the favorable effect of protein on the IGF-1 axis to dominate. Several, although not all, studies are either compatible with or support this hypothesis. Protein supplements significantly reduced bone loss in elderly hip-fracture patients in a study in which both the protein and control groups received supplemental calcium. In an observational study, total protein intake was positively associated with favorable 3-y changes in femoral neck and total body bone mineral density in volunteers who received supplemental calcium citrate malate and vitamin D, but not in volunteers taking placebos. In conclusion, an adequate calcium intake may help promote a favorable effect of dietary protein on the skeleton in older individuals.

PMID: 12612168


Proc Nutr Soc. 2003 Nov;62(4):867-76.

Dietary protein and bone health.

...Prospective studies in the elderly in the USA have shown that the greatest bone losses occur in elderly men and women with an average protein intake of 16-50 g/d....

PMID: 15018487


J Bone Miner Res. 2004 Apr;19(4):537-45. Epub 2004 Feb 9.

Dietary protein intake and risk of osteoporotic hip fracture in elderly residents of Utah.

...Higher total protein intake was associated with a reduced risk of hip fracture in men and women 50-69 years of age but not in men and women 70-89 years of age. ...Our study supports the hypothesis that adequate dietary protein is important for optimal bone health in the elderly 50-69 years of age.

PMID: 15005839


J Clin Endocrinol Metab. 2005 Jan;90(1):26-31. Epub 2004 Nov 16.

The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women.

...There were no protein-induced effects on net bone balance. These data directly demonstrate that, at least in the short term, high-protein diets are not detrimental to bone.

PMID: 15546911


Am J Clin Nutr. 2005 Jun;81(6):1423-8.

Protein consumption is an important predictor of lower limb bone mass in elderly women.

...positive correlation between protein intake and qualitative ultrasound of the heel and BMD ...These data suggest that protein intakes for elderly women above current recommendations may be necessary to optimize bone mass.

PMID: 15941897


Calcif Tissue Int. 2008 May;82(5):373-82.

Influence of high and low protein intakes on age-related bone loss in rats submitted to adequate or restricted energy conditions.

Low energy and protein intake has been suggested to contribute to the increased incidence of osteoporosis in the elderly. ...After 5 months of the experiment, protein intake (13% or 26%) did not modulate calcium retention or bone status in those rats, although a low-grade metabolic acidosis was induced with the HP diet. Both restrictions (PER and ER) decreased femoral bone mineral density and fracture load...

PMID: 18437274


Am J Clin Nutr. 2008 May;87(5):1567S-1570S.

Amount and type of protein influences bone health.

...Protein has been identified as being both detrimental and beneficial to bone health, depending on a variety of factors, including the level of protein in the diet, the protein source, calcium intake, weight loss, and the acid/base balance of the diet....Factors that affect muscle anabolism, including protein intake, also affect bone mass. ...Calcium and protein intake interact constructively to affect bone health. Intakes of both calcium and protein must be adequate to fully realize the benefit of each nutrient on bone. Optimal protein intake for bone health is likely higher than current recommended intakes, particularly in the elderly. Concerns about dietary protein increasing urinary calcium appear to be offset by increases in absorption. Likewise, concerns about the impact of protein on acid production appear to be minor compared with the alkalinizing effects of fruits and vegetables. Perhaps more concern should be focused on increasing fruit and vegetable intake rather than reducing protein sources.

PMID: 18469289


Public Health Nutr. 2008 Jun;11(6):564-72. Epub 2007 Aug 9.

Effects of meat consumption and vegetarian diet on risk of wrist fracture over 25 years in a cohort of peri- and postmenopausal women.

...The finding that higher consumption frequencies of foods rich in protein were associated with reduced WF supports the importance of adequate protein for bone health. The similarity in risk reduction by vegetable protein foods compared with meat intake suggests that adequate protein intake is attainable in a vegetarian diet.

PMID: 17686206


Am J Clin Nutr. 2009 May;89(5):1357-65.

Dietary protein and calcium interact to influence calcium retention: a controlled feeding study.

...In healthy postmenopausal women, a moderate increase in dietary protein, from 10% to 20% of energy, slightly improved calcium absorption from a low-calcium diet, nearly compensating for a slight increase in urinary calcium excretion. Under practical dietary conditions, increased dietary protein from animal sources was not detrimental to calcium balance or short-term indicators of bone health.

PMID: 19279077


Nutrition. 2009 Jun;25(6):647-54.

Association of total calcium and dietary protein intakes with fracture risk in postmenopausal women: the 1999-2002 National Health and Nutrition Examination Survey (NHANES).

...In women who consumed <46 g/d of dietary protein, those with a TCI >or=1200 mg/d had a significantly higher risk of fracture than those with the lowest TCI ...whereas in women who consumed >70 g/d of dietary protein, those with a TCI >or=1200 mg/d had an insignificant lower risk of fracture (adjusted odds ratio 0.69, 95% confidence interval 0.20-2.39)....

PMID: 19230618


J Bone Miner Res. 2010 Dec;25(12):2770-6.

Protective effect of high protein and calcium intake on the risk of hip fracture in the Framingham offspring cohort.

...In the 800 mg/day or more group, T3 of animal protein had an 85% reduced hip fracture risk ... Our results from middle-aged men and women show that higher animal protein intake coupled with calcium intake of 800 mg/day or more may protect against hip fracture, whereas the effect appears reversed for those with lower calcium intake....

PMID: 20662074


Osteoporos Int. 2011 Jan;22(1):345-9.

Does dietary protein reduce hip fracture risk in elders? The Framingham Osteoporosis Study.

...Our results are consistent with reduced risk of hip fracture with higher dietary protein intake...

PMID: 20442986


Int J Vitam Nutr Res. 2011 Mar;81(2-3):134-42.

Protein intake and bone health.

Adequate nutrition plays an important role in the development and maintenance of bone structures resistant to usual mechanical stresses. In addition to calcium in the presence of an adequate supply of vitamin D, dietary proteins represent key nutrients for bone health and thereby function in the prevention of osteoporosis. Several studies point to a positive effect of high protein intake on bone mineral density or content. This fact is associated with a significant reduction in hip fracture incidence, as recorded in a large prospective study carried out in a homogeneous cohort of postmenopausal women. Low protein intake (< 0.8 g/kg body weight/day) is often observed in patients with hip fractures and an intervention study indicates that following orthopedic management, protein supplementation attenuates post-fracture bone loss, tends to increase muscle strength, and reduces medical complications and rehabilitation hospital stay. There is no evidence that high protein intake per se would be detrimental for bone mass and strength. Nevertheless, it appears reasonable to avoid very high protein diets (i. e. more than 2.0 g/kg body weight/day) when associated with low calcium intake (i. e. less than 600 mg/day). In the elderly, taking into account the attenuated anabolic response to dietary protein with ageing, there is concern that the current dietary protein recommended allowance (RDA), as set at 0.8 g/kg body weight/day, might be too low for the primary and secondary prevention of fragility fractures.

PMID: 22139564


Nutr Rev. 2011 Apr;69(4):215-30.

Dietary protein and bone health: harmonizing conflicting theories.

...However, recent clinical studies and a meta-analysis have indicated either no effect or a modest benefit associated with higher protein intakes. These contradictory considerations may be explained by the existence of a two-faced relationship between protein and bone, with simultaneous positive and negative pathways. In opposition to the negative effects of dietary acid load, protein may exert positive effects related to improving calcium absorption, increasing insulin-like growth factor 1, or improving lean body mass, which, in turn, improves bone strength....When positive and negative pathways are considered in tandem, protein may offer modest benefits to bone in the presence of adequate dietary calcium and acid-neutralizing fruits and vegetables.

PMID: 21457266


J Nutr. 2011 Mar;141(3):391-7.

A diet high in meat protein and potential renal acid load increases fractional calcium absorption and urinary calcium excretion without affecting markers of bone resorption or formation in postmenopausal women.

...a high-protein diet has no adverse effects on bone health.

PMID: 21248199


Curr Opin Lipidol. 2011 Feb;22(1):16-20.

Dietary protein and skeletal health: a review of recent human research.

...Recent epidemiological, isotopic and meta-analysis studies suggest that dietary protein works synergistically with calcium to improve calcium retention and bone metabolism. The recommendation to intentionally restrict dietary protein to improve bone health is unwarranted, and potentially even dangerous to those individuals who consume inadequate protein.

PMID: 21102327


J Bone Miner Metab. 2011 Jan;29(1):1-14.

The interaction between dietary protein and bone health.

...There is not enough evidence currently to suggest that animal protein is superior or inferior to vegetable protein, or that milk or soy protein, respectively, is more favorable than other protein sources.

PMID: 20972896


Clin Nutr. 2012 Jun;31(3):391-5.

Protein intake and fracture risk in elderly people: a case-control study.

...Patients with fracture history have lower API suggesting that high API reduce the occurrence of OP in elderly even if CaI is <800 mg/day. A PI<15% of total calories were associated with an increased risk of OP in elderly.

PMID: 22182947

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