The resources listed below represent a collection of scientific articles discussing research on the overall effects of chronic, low-grade, metabolic acidosis on health. These sources provide a useful collection of observations for those interested in expanding their understanding of the health impacts of pH imbalance and the importance of acid-alkaline balance.
Alonso, A., de la Fuente, C., et al. (2004). Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study. Br J Nutr 92(2): 311-9. PMID: 15333163
Alpern, R.J., Sakhaee, K. (1997). The clinical spectrum of chronic metabolic acidosis: homeostatic mechanisms produce significant morbidity. Am J Kidney Dis 29(2): 291-302. PMID: 9016905
Berardi, J. M., A. C. Logan, and A. V. Rao. (2008). Plant based dietary supplement increases urinary pH. J Int Soc Sports Nutr 5:20.
Brüngger, M., H. N. Hulter, and R. Krapf. (1997). Effect of chronic metabolic acidosis on the growth hormone/IGF-1 endocrine axis: New cause of growth hormone insensitivity in humans. Kidney Int 51(1):216-21.
Bushinsky, D.A. (2002). Recurrent hypercalciuric nephrolithiasis—does diet help? N Engl J Med 346(2): 124-5. PMID: 11784880
Ceglia, L., S. Harris, S. Abrams, et al. (2009). Potassium bicarbonate attenuates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption. J Clin Endocrinol Metab 94(2): 645-653.
Coppoolse, R., T. J. Barstow, W.W. Stringer, et al. (1997). Effect of acute bicarbonate administration on exercise responses of COPD patients. Med Sci Sports Exerc 29: 725-732.
Cordain, L., S. B. Eaton, et al. (2005). Origins and evolution of the Western diet: Health implications for the 21st century. Am J Clin Nutr 81:341-54.
Cordain, L., Miller, J.B., et al. (2000). Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. Am J Clin Nutr 71(3): 682-92. PMID: 10702160
De Brito-Ashurst, I., M. Varagunam, et al. (2009). Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol 20(9):2075-84.
Demigné, C. (2006). Could minor cations and anions or other constituents such as fibers, contribute to the alkalinising properties of plant foods? 2nd International Acid-Base Symposium, Munich, 8 – 9 September.
Eaton, S. B. and M. Konner. 1985. Paleolithic nutrition—A consideration of its nature and current implications. New Engl. J Med 312:283–289.
Demigne, C. Could minor cations and anions or other constituents such as fibers, contribute to the alkalinising properties of plant foods? 2nd International Acid-Base Symposium: Nutrition - Health - Disease, Welhenstephan, Germany. http://www.saeure-basen-forum.de/pdf/symp2006/abstracts/Demign_Christian.pdf
Eaton, S.B., Eaton, S.B., 3rd (2000). Paleolithic vs. modern diets—selected pathophysiological implications. Eur J Nutr 39(2): 67-70. PMID: 10918987
Farr, M., Garvey, K., et al. (1985). Significance of the hydrogen ion concentration in synovial fluid in rheumatoid arthritis. Clin Exp Rheumatol 3(2): 99-104. PMID: 4017318
Feely, R. A., Sabine, C.L., et al. (2004). Impact of anthropogenic CO2 on the CaCO3 system in the oceans. Science 305(5682): 362-6. PMID: 15256664
Frangiosa, A., L.S. DeSanto, P. Anastasio, et al. (2006). Acid-base balance in heart failure. J Nephrol 19(9 Suppl): S115-S120.
Frassetto, L. A., R.C. Morris, Jr., and A. Sebastian. (2007). Dietary sodium chloride intake independently predicts the degree of hyperchloremic metabolic acidosis in healthy humans consuming a net acid-producing diet. Am J Physiol Renal Physiol 93: 521-525.
Frassetto, L. A., M. Schloetter, et al. (2009). Metabolic and psysiologic improvements from consuming a paleolithic, hunter-gatherer type diet. Eur J Clin Nutr 63(8):947-55.
Frassetto, L., Morris, R.C. Jr., et al. (2001). 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 40(5): 200-13. http://www.saeure-basen-forum.de/pdf/symp2001/frassetto.pdf
Gonick, H. C., Goldberg, G., et al. (1968). Reexamination of the acid-ash content of several diets. Am J Clin Nutr 21(9): 898-903. PMID: 5675852
Guyton, A. C. 1961 Textbook of medical physiology. Philadelphia: Saunders.
Hosch, M., Muser, J., Hulter, H.N., Krapf, R. (2004). Ureagenesis: evidence for a lack of hepatic regulation of acid-base equilibrium in humans. Am J Physiol Renal Physiol (286): F94-9. PMID: 14656759
Hunt, J. R., L. K. Johnson, and Z. K. Fariba Roughead. (2009). Dietary protein and calcium interact to influence calcium retention: A controlled feeding study. Am J Clin Nutr 89:1357-65.
Jaffe, R. (2000). Autoimmunity and cofactor replacement. Int J Integr Med 2(2).
Kiwull-Schone, H., Kalhoff, H., et al. (2001). Minimal-invasive approach to study pulmonary, metabolic and renal responses to alimentary acid-base changes in conscious rabbits. Eur J Nutr 40(5): 255-9. http://www.saeure-basen-forum.de/pdf/symp2001/kiwull_schoene.pdf
Lemann, Jr., J., R.W. Gray, and J.A. Pleuss. (1989). Potassium bicarbonate, but not sodium bicarbonate, reduces urinary calcium excretion and improves calcium balance in healthy men. Kidney Int 35: 688-695.
Lofberg, E., A. Gutierrez, B. Anderstam, et al. (2006). Effect of bicarbonate on muscle protein in patients receiving hemodialysis. Am J Kidney Dis 48: 419-429.
Lukaski, H.C. (2005). Low dietary zinc decreases erythrocyte carbonic anhydrase activities and impairs cardiorespiratory function in men during exercise. Am J Clin Nutr 81(5): 1045-51. PMID: 15883427
Maalouf, N.M., M.A. Cameron, O.W. Moe, et al. (2007). Low urine pH: A novel feature of the metabolic syndrome. Clin J Am Soc Nephrol 2: 883-888.
Manz, F., Remer, T., et al. (1995). Effects of a high protein intake on renal acid excretion in bodybuilders. Z Ernahrungswiss 34(1): 10-5. PMID: 7785291
Martin, H.E., Wertman, M. (1947). Serum potassium, magnesium, and calcium levels in diabetic acidosis. J Clin Invest 26(2): 217-28. PMID: 16695408
McCarty, M. (2005). Acid-base balance may influence risk for insulin resistance syndrome by modulating cortisol output. Med Hypotheses 64: 380-384. PMID: 15607573
Mitch, W.E., R. Medina, S. Grieber, et al. (1994). Metabolic acidosis stimulates muscle protein degradation by activating the adenosine triphosphate-dependent pathway involving ubiquitin and proteasomes. J Clin Invest 93: 2127-2133.
Morris, R.C., Jr., Sebastian, A. (2002). Alkali therapy in renal tubular acidosis: who needs it? J Am Soc Nephrol 13(8): 2186-8. PMID: 12138154
Pizzorno, J., L. A. Frassetto, and J. Katzinger. (2010). Diet-induced acidosis: Is it real and clinically relevant? Br J Nutr 103(8):1185-94.
Queen, S. (1994). Free radical therapy: part IV: acidemia and free calcium excess. Health Realities Journal.
Relman, A.S., Lennon, E.J., et al. (1961). Endogenous production of fixed acid and the measurement of the net balance of acid in normal subjects. J Clin Invest 40: 1621-30. PMID: 13740723
Remer, T., Manz, F. (2003). Paleolithic diet, sweet potato eaters, and potential renal acid load. Am J Clin Nutr 78(4): 802-3; author reply 803-4. PMID: 14522740
Robergs, R.A., Ghiasvand, F., et al. (2004). Biochemistry of exercise-induced metabolic acidosis. Am J Physiol Regul Integr Comp Physiol 287(3): R502-16. PMID: 15308499
Sabine, C.L., Feely, R.A., et al. (2004). The oceanic sink for anthropogenic CO2. Science 305(5682): 367-71. PMID: 15256665
Spiller, G.A., Bruce, B. (1998). Vegan diets and cardiovascular health [editorial; comment]. J Am Coll Nutr 17(5): 407-8. PMID: 9791835
Stratton-Phelps, M., House, J.K. (2004). Effect of a commercial anion dietary supplement on acid-base balance, urine volume, and urinary ion excretion in male goats fed oat or grass hay diets. Am J Vet Res 65(10): 1391-7. PMID: 15524326
Ströhle, A., A. Hahn, and A. Sebastian. (2010). Latitude, local ecology, and hunter-gatherer dietary acid load: Implications from evolutionary ecology. Am J Clin Nutr 92(4):940-5.
Vormann, J., Worlitschek, M., et al. (2001). Supplementation with alkaline minerals reduces symptoms in patients with chronic low back pain. J Trace Elem Med Biol 15(2-3): 179-83. PMID: 11787986
Weisinger, J.R., Favus, M.J., et al. (1989). Regulation of 1,25-dihydroxyvitamin D3 by calcium in the parathyroidectomized, parathyroid hormone-replete rat. J Bone Miner Res 4(6): 929-35. PMID: 2610024
Wenzel, U. E. A. (2000). Membrane transport proteins and their role in acid base homeostasis. Acid-Base Metabolism: Nutrition - Health - Disease, Welhenstephan, Germany.
Whiting, S.J. and J.A. Muirhead. (2005). Measurement of net acid excretion by use of paper strips. Nutrition 21: 961-963.
Wiederkehr, M. R., J. Kalogiros; and R. Krapf. (2004). Correction of metabolic acidosis improves thyroid and growth hormone axes in haemodialysis patients. Nephrology Dialysis Transplantation 19(5): 1190-97.
Wiederseiner, J. M., J. Muser, T. Lutz, H. N. Hulter, and R. Krapf. (2004). Acute metabolic acidosis: Characterization and diagnosis of the disorder and the plasma potassium response. J Am Soc Nephrol 15: 1589-1596.
Acid-alkaline balance and bone health: research articles of special interest
by Dr. Susan E. Brown, PhD
The resources listed below represent a collection of scientific articles discussing research on the effects of chronic, low-grade metabolic acidosis on bone, including studies relating acidbase balance to osteopenia and osteoporosis. These sources represent an expanding database of observations that support pH balance as a necessary component of full bone health.
Abelow, B. J. et al. 1992 Cross-cultural association between dietary animal protein and hip fracture: A hypothesis. Calcif Tiss Int 50:14–18.
Alexy, U., T. Remer, et al. (2005). Long-term protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children. Am J Clin Nutr 82:1107-14.
Amanzadeh, J., Gitomer, W.L., et al. (2003). Effect of high protein diet on stone-forming propensity and bone loss in rats. Kidney Int 64(6): 2142-9. PMID: 14633136
Arnett, T. R. and D. W. Dempster. 1986. Effect of pH on bone resorption by rat osteoclasts in vitro. Endocrin 119:119–124.
Arnett, T. (2003). Regulation of bone cell function by acid-base balance. Proc Nutr Soc 62(2): 511-20. PMID: 14506899
Arnett, T. R., Spowage, M. (1996). Modulation of the resorptive activity of rat osteoclasts by small changes in extracellular pH near the physiological range. Bone 18(3): 277-9. PMID: 8703584
Bäckman, T. (1999). Acid-base balance, dentinogenesis, and dental caries. Faculty of Medicine, University of Oulu, Finland.
Ballard, T. L., Clapper, J.A., et al. (2005). Effect of protein supplementation during a 6-mo strength and conditioning program on insulin-like growth factor I and markers of bone turnover in young adults. Am J Clin Nutr 81(6): 1442-8. PMID: 15941900
Barzel, U.S., Jowsey, J. (1969). The effects of chronic acid and alkali administration on bone turnover in adult rats. Clin Sci 36(3): 517-24. PMID: 5795240
Barzel, U.S., Massey, L.K. (1998). Excess dietary protein can adversely affect bone. J Nutr 128(6): 1051-3. PMID: 9614169
Brandao-Burch, A., J.C. Utting, I.R. Orriss, et al. (2005). Acidosis inhibits bone formation by osteoblasts in vitro by preventing mineralization. Calcif Tissue Int 77: 167-174.
Breslau, N.A., Brinkley, L., et al. (1988). Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab 66(1): 140-6. PMID: 2826524
Buclin, T., Cosma, M., et al. (2001). Diet acids and alkalis influence calcium retention in bone. Osteoporos Int 12(6): 493-9. PMID: 11446566
Budde, R.A., Crenshaw, T.D. (2003). Chronic metabolic acid load induced by changes in dietary electrolyte balance increased chloride retention but did not compromise bone in growing swine. J Anim Sci 81(1): 197-208. PMID: 12597391
Burket, J. C., J. MacLeay, et al. (2010). Variations in cancellous bone tissue composition and mechanical properties with a model of osteoporosis and treatment in sheep. Presentation number SU0048, ASBMR Conference, Toronto, Canada.
Bushinsky, D.A. (1987). Effects of parathyroid hormone on net proton flux from neonatal mouse calvariae. Am J Physiol 252(4 Pt 2): F585-9. PMID: 3031997
Bushinsky, D.A. (1989). Internal exchanges of hydrogen ions: bone. In: Seldein D.W.,
Giebisch, G., eds. The regulation of acid-base balance. New York: Raven Press, pp. 69-88.
Bushinsky, D.A. (1995). Stimulated osteoclastic and suppressed osteoblastic activity in metabolic but not respiratory acidosis. Am J Physiol 268(1 Pt 1): C80-8. PMID: 7840163
Bushinsky, D.A. (1996). Metabolic alkalosis decreases bone calcium efflux by suppressing osteoclasts and stimulating osteoblasts. Am J Physiol 271(1 Pt 2): F216-22. PMID: 8760264
Bushinsky, D.A., Coe, F.L. (1985). Hyperkalemia during acute ammonium chloride acidosis in man. Nephron 40(1): 38-40. PMID: 3923378
Bushinsky, D.A., Gavrilov, K., et al. (1997). Effect of metabolic acidosis on the potassium content of bone. J Bone Miner Res 12(10): 1664-71. PMID: 9333127
Bushinsky, D.A., Gavrilov, K., et al. (1996). Effects of osteoclastic resorption on bone surface ion composition. Am J Physiol 271(4 Pt 1): C1025-31. PMID: 8897806
Bushinsky, D.A., Krieger, N.S., et al. (1983). Effects of pH on bone calcium and proton fluxes in vitro. Am J Physiol 245(2): F204-9. PMID: 6881337
Bushinsky, D.A., Lechleider, R.J. (1987). Mechanism of proton-induced bone calcium release: calcium carbonate-dissolution. Am J Physiol 253(5 Pt 2): F998-1005. PMID: 2825542
Bushinsky, D.A., Levi-Setti, R., et al. (1986). Ion microprobe determination of bone surface elements: effects of reduced medium pH. Am J Physiol 250(6 Pt 2): F1090-7. PMID: 3717349
Bushinsky, D.A., Nilsson, E.L. (1995). Additive effects of acidosis and parathyroid hormone on mouse osteoblastic and osteoclastic function. Am J Physiol 269(6 Pt 1): C1364-70. PMID:8572164
Bushinsky, D.A., Sessler, N.E. (1992). Critical role of bicarbonate in calcium release from bone. Am J Physiol 263(3 Pt 2): F510-5. PMID: 1415579
Bushinsky, D.A., Sessler, N.E., et al. (1994). Proton-induced physicochemical calcium release from ceramic apatite disks. J Bone Miner Res 9(2): 213-20. PMID: 8140934
Bushinsky, D.A., Sessler, N.E., et al. (1992). Greater unidirectional calcium efflux from bone during metabolic, compared with respiratory, acidosis. Am J Physiol 262(3 Pt 2): F425-31.PMID: 1558159
Bushinsky, D.A., Smith, S.B., et al. (2002). Acute acidosis-induced alteration in bone bicarbonate and phosphate. Am J Physiol Renal Physiol 283(5): F1091-7. PMID: 12372785
Bushinsky, D.A., Smith, S.B., et al. (2003). Chronic acidosis-induced alteration in bone bicarbonate and phosphate. Am J Physiol Renal Physiol 285(3): F532-9. PMID: 12759230
Canas, F., Terepka, A.R., et al. (1969). Potassium and milieu interieur of bone. Am J Physiol 217(1): 117-20. PMID: 5785866
Carter, J.D., Vasey, F.B., et al. (2006). The effect of a low-carbohydrate diet on bone turnover. Osteoporos Int 17(9): 1398-403. PMID: 16718399
Cochran, M., Wilkinson, R. (1975). Effect of correction of metabolic acidosis on bone mineralisation rates in patients with renal osteomalacia. Nephron 15: 98-110.
Dargent-Molina, P., S. Sabia, et al. (2008). Proteins, dietary acid load, and calcium and risk of post-menopausal fractures in the E3N French Women Prospective Study. J Bone Miner Res 23(12):1915-22.
Dawson-Hughes, B., S.S. Harris, N.J. Palermo, et al. (2009). Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women. J Clin Endocrinol Metab 94: 96-102.
Dawson-Hughes, B., Harris, S.S., et al. (2008). Alkaline diets favor lean tissue mass in older adults. Am J Clin Nutr 87(3): 662-5. PMID: 18326605
Dawson-Hughes, B., Harris, S.S., et al. (2004). Effect of dietary protein supplements on calcium excretion in healthy older men and women. J Clin Endocrinol Metab 89(3): 1169-73.PMID: 15001604
Dawson-Hughes, B., Harris, S.S. (2002). Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr 75(4): 773-779. ID: 11916767
Devine, A., Prince, R.L., et al. (1996). Nutritional effect of calcium supplementation by skim milk powder or calcium tablets on total nutrient intake in postmenopausal women. Am J Clin Nutr 64(5): 731-7. PMID: 8901793
Domrongkitchaiporn, S., Pongsakul, C., et al. (2001). Bone mineral density and histology in distal renal tubular acidosis. Kidney Int 59(3): 1086-93. PMID: 11231364
Domrongkitchaiporn, S., Pongsakul, C., et al. (2002). Bone histology and bone mineral density after correction of acidosis in distal renal tubular acidosis. Kidney Int 62(6): 2160-6.PMID: 12427141
Duff, T.L., Whiting, S.J. (1998). Calciuric effects of short-term dietary loading of protein, sodium chloride and potassium citrate in prepubescent girls. J Am Coll Nutr 17(2): 148-54. PMID: 9550458
Fenton, T.R., A.W. Lyon, M. Eliaziw, et al. (2009). Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res 24: 1835-1840.
Fenton, T. R., A. W. Lyon, M. Eliasziw, et al. (2009). Phosphate decreases urine calcium and increases calcium balance: A meta-analysis of the osteoporosis acid-ash diet hypothesis.Nutr J 8:41.
Fenton, T. R., M. Eliasziw, et al. (2010). Bone fractures or the loss of bone mineral density: A prospective cohort study. BMC Musculo Dis 11:88.
Frassetto, L., R.C. Morris Jr., and A. Sebastian. (1997). Potassium bicarbonate reduces urinary nitrogen excretion in postmenopausal women. J Clin Endocrinol Metab 82: 254-259.
Frassetto, L., R.C. Morris, Jr. and A. Sebastian. (2004). Diet acid load and bone health. In Nutritional Aspects of Osteoporosis, 2nd ed. Ed. P. Burckhardt, B. Dawson-Hughes and R.P. Heaney. San Diego, CA: Elsevier Academic Press.
Frassetto, L., Morris, R.C. Jr., et al. (1997). Potassium bicarbonate reduces urinary nitrogen
excretion in postmenopausal women. J Clin Endocrinol Metab 82(1): 254-9.
Frassetto, L., Morris, R.C. Jr., et al. (2005). Long-term persistence of the urine calciumlowering effect of potassium bicarbonate in postmenopausal women. J Clin Endocrinol Metab
90(2): 831-4. PMID: 15572425
Frassetto, L., Sebastian, A. (1996). Age and systemic acid-base equilibrium: analysis of
published data. J Gerontol A Biol Sci Med Sci 51(1): B91-9. PMID: 8548506
Frassetto, L.A., Morris, R.C. Jr., et al. (1996). Effect of age on blood acid-base composition
in adult humans: role of age-related renal functional decline. Am J Physiol 271(6 Pt 2):
F1114-22.
Frassetto, L.A., Nash, E., et al. (2000). Comparative effects of potassium chloride and
bicarbonate on thiazide-induced reduction in urinary calcium excretion. Kidney Int 58(2):
748-52. PMID: 10916098
Frassetto, L.A., Todd, K.M., et al. (1998). Estimation of net endogenous noncarbonic acid
production in humans from diet potassium and protein contents. Am J Clin Nutr 68(3): 576-
83. PMID: 9734733
Frassetto, L.A., Todd, K.M., et al. (2000). Worldwide incidence of hip fracture in elderly
women: relation to consumption of animal and vegetable foods. J Gerontol Biol Sci Med Sci
55(10): M585-92. PMID: 11034231
Frick, K.K., Bushinsky, D.A. (1998). Chronic metabolic acidosis reversibly inhibits
extracellular matrix gene expression in mouse osteoblasts. Am J Physiol 275(5 Pt 2): F840-
7. PMID: 9815143
Frick, K.K., Bushinsky, D.A. (2003). Metabolic acidosis stimulates RANKL RNA expression in
bone through a cyclo-oxygenase-dependent mechanism. J Bone Miner Res 18(7): 1317-25.
PMID: 12854843Frings-Meuthen, P., N. Baecker, and M. Heer. (2008). Low-grade metabolic acidosis may be
the cause of sodium-chloride induced exaggerated bone resorption. J Bone Miner Res 23:
517-524.
Green, J., Kleeman C.R. (1991). The role of bone in the regulation of systemic acid-base
balance. Contrib Nephrol 91: 61-76. PMID: 1800012
Grinspoon, S.K., Baum, H.B., et al. (1995). Decreased bone formation and increased
mineral dissolution during acute fasting in young women. J Clin Endocrinol Metab 80(12):
3628-33. PMID: 8530611
Grinspoon, S.K., Baum, H.B., et al. (1995). Decreased bone formation and increased
mineral dissolution during acute fasting in young women. J Clin Endocrinol Metab 80(12):
3628-33. PMID: 8530611
Hardcastle, A. C., L. Aucott, et al. (2011). Dietary patterns, bone resorption and bone
mineral density in early post-menopausal Scottish women. Eur J Clin Nutr 65:378-85.
Heaney, R., Weaver, C., et al. (1993). Absorbability of calcium from brassica vegetables:
broccoli, bok choy, and kale. J Food Sci 58(6): 1378-80.
Heersche, J.N., Bellows, C.G., et al. (1998). The decrease in bone mass associated with
aging and menopause. J Prosthet Dent 79(1): 14-6. PMID: 9474535
Hegarty, V.M., May, H.M., et al. (2000). Tea drinking and bone mineral density in older
women. Am J Clin Nutr 71(4): 1003-7. PMID: 10731510
Henriksen, K., Sorensen, M.G., et al. (2006). Degradation of the organic phase of bone by
osteoclasts: a secondary role for lysosomal acidification. J Bone Miner Res 21(1): 58-66.
PMID: 16355274
Hood, V.L., Tannen, R. L. (1998). Protection of acid-base balance by pH regulation of acid
production. N Engl J Med 339(12): 819-26. PMID: 9738091
Hu, J. F., Zhao, X.H., et al. (1993). Dietary intakes and urinary excretion of calcium and
acids: a cross-sectional study of women in China. Am J Clin Nutr 58(3): 398-406. PMID:
8237852
Jaffe, R. and S. E. Brown. 2000. Acid alkaline balance and its effect on bone health. Int. J.
Integ. Med. 2(6).
Jajoo, R., Song, L., et al. (2006). Dietary acid-base balance, bone resorption, and calcium
excretion. J Am Coll Nutr 25(3): 224-30. PMID: 16766781
Jehle, S., Zanetti, A., et al. (2006). Partial neutralization of the acidogenic Western diet with
potassium citrate increases bone mass in postmenopausal women with osteopenia. J Am
Soc Nephrol 17(11): 3213-22. PMID: 17035614
Kalhoff, H., Manz, F. (2001). Nutrition, Acid-Base Status and Growth in Early Childhood. Eur
Kerstetter, J. E., Mitnick, M.E., et al. (1999). Changes in bone turnover in young women
consuming different levels of dietary protein. J Clin Endocrinol Metab 84(3): 1052-5. PMID:
10084594
Klevay, L. M., Wildman, R.E. (2002). Meat diets and fragile bones: inferences about
osteoporosis. J Trace Elem Med Biol 16(3): 149-54. PMID: 12437150
Kocian, J., Brodan, V. (1979). Simultaneous correction of Ca deficiency and acidosis in
fasting obese patients as a prevention of bone demineralisation. Nutr Metab 23(5): 391-8.
PMID: 481830
Komarova, S.V., Pereverzev, A., et al. (2005). Convergent signaling by acidosis and
receptor activator of NF-kappaB ligand (RANKL) on the calcium/calcineurin/NFAT pathway in
osteoclasts. Proc Natl Acad Sci U S A 102(7): 2643-8. PMID: 15695591
Krieger, N. S., Frick, K.K., et al. (2002). Cortisol inhibits acid-induced bone resorption in
vitro. J Am Soc Nephrol 13(10): 2534-9. PMID: 12239242
Krieger, N. S., Sessler, N.E., et al. (1992). Acidosis inhibits osteoblastic and stimulates
osteoclastic activity in vitro. Am J Physiol 262(3 Pt 2): F442-8. PMID: 1558161Krieger, N. S., Sukhatme, V.P., et al. (1990). Conditioned medium from ras oncogenetransformed NIH 3T3 cells induces bone resorption in vitro. J Bone Miner Res 5(2): 159-64.
PMID: 2180257
Krieger, N, S. Yee, et al. (2009). Metabolic acidosis stimulates RGS2 and inhibits RGS16 in
osteoblasts. Presentation number SU0208, ASBMR 31st Annual Meeting, Colorado.
Kurtz, I., Maher, T. et al. (1983). Effect of diet on plasma acid-base composition in normal
humans. Kidney Int 24(5): 670-80. PMID: 6663989
Lacey, J. M., J. J., erson, et al. (1991). Correlates of cortical bone mass among
premenopausal and postmenopausal Japanese women. J Bone Miner Res 6(7): 651-9.
PMID: 1950670
Lanham-New, S. (2008). The balance of bone health: Tipping the scales in favor of
potassium-rich, bicarbonate-rich foods. J Nutr 138: 172S-177S.
Lau, K., Wolf, C., et al. (1979). Differing effects of acid versus neutral phosphate therapy of
hypercalciuria. Kidney Int 16(6): 736-42. PMID: 44888
Lemann, J., Jr., Adams, N.D., et al. (2000). Acid and mineral balances and bone in familial
proximal renal tubular acidosis. Kidney Int 58(3): 1267-77. PMID: 10972690
Lemann, J., Jr., Bushinsky, D.A., et al. (2003). Bone buffering of acid and base in humans.
Am J Physiol Renal Physiol 285(5): F811-32. PMID: 14532161
Lemann, J., Jr., Gray, R.W. et al. (1986). The importance of renal net acid excretion as a
determinant of fasting urinary calcium excretion. Kidney Int 29(3): 743-6. PMID: 3702225
Lemann, J., Jr., Litzow, J.R., et al. (1966). The effects of chronic acid loads in normal man:
further evidence for the participation of bone mineral in the defense against chronic
metabolic acidosis. J Clin Invest 45(10): 1608-14. PMID: 5927117
Lemann, J., Jr., Pleuss, J.A., et al. (1993). Potassium causes calcium retention in healthy
adults. J Nutr 123(9): 1623-6. PMID: 8360791
Lemann, J., Jr., Pleuss, J.A., et al. (1991). Potassium administration reduces and potassium
deprivation increases urinary calcium excretion in healthy adults [corrected]. Kidney Int
39(5): 973-83. PMID: 1648646
Lennon, E.J., Lemann, J. Jr., et al. (1966). The effects of diet and stool composition on the
net external acid balance of normal subjects. J Clin Invest 45(10): 1601-7. PMID: 5925517
Lewis, N.M., Marcus, M.S., et al. (1989). Calcium supplements and milk: effects on acidbase balance and on retention of calcium, magnesium, and phosphorus. Am J Clin Nutr
49(3): 527-33. PMID: 2923085
Licata, A.A., Bou, E., et al. (1981). Acute effects of dietary protein on calcium metabolism in
patients with osteoporosis. J Gerontol 36(1): 14-9. PMID: 7451829
Lin, P.H., Ginty, F., et al. (2003). The DASH diet and sodium reduction improve markers of
bone turnover and calcium metabolism in adults. J Nutr 133(10): 3130-6. PMID: 14519796
MacDonald, H.M., New, S.A., et al. (2005). Low dietary potassium intakes and high dietary
estimates of net endogenous acid production are associated with low bone mineral density
in premenopausal women and increased markers of bone resorption in postmenopausal
women. Am J Clin Nutr 81(4): 923-33. PMID: 15817873
MacDonald, H.M., New, S.A., et al. (2004). Nutritional associations with bone loss during the
menopausal transition: Evidence of a beneficial effect of calcium, alcohol, and fruit and
vegetable nutrients and of a detrimental effect of fatty acids. Am J Clin Nutr. 79: 155-65
Manz, F. (2001). History of nutrition and acid-base physiology. Eur J Nutr 40(5): 189-99.
Marangella, M., M. Di Stefano, et al. (2004). Effects of potassium citrate supplementation on
bone metabolism. Calcif Tissue Int 74(4): 330-5. PMID: 15255069
Massey, L. K., Whiting S.J. (1996). Dietary salt, urinary calcium, and bone loss. J Bone
Miner Res 11(6): 731-6. PMID: 8725169Maurer, M., W. Riesen, J. Muser, H. N. Hulter, R. Krapf. (2003). Neutralization of western
diet inhibits bone resorption independently of K intake and reduces cortisol secretion in
humans. Am J Physiol Renal Physiol 284: F32-F40.
May, R.C., Kelly, R.A., et al. (1986). Metabolic acidosis stimulates protein degradation in rat
muscle by a glucocorticoid-dependent mechanism. J Clin Invest 77(2): 614-21. PMID:
3511100
McGartland, C.P., Robson, P.J., et al. (2004). Fruit and vegetable consumption and bone
mineral density: the Northern Ireland Young Hearts Project. Am J Clin Nutr 80(4): 1019-23.
PMID: 15447914
McLean, R. R., N. Qiao, et al. (2011). Dietary acid load is not associated with lower bone
mineral density except in older men. J Nutr 141:588-94.
McTieran, A., J. Wactawski-Wende, et al. (2009). Low-fat, increased fruit, vegetable, and
grain dietary pattern, fractures, and bone mineral density: The Women’s Health Initiative
Dietary Modification Trial. Am J Clin Nutr 89(6):1864-76.
Meghji, S., Morrison, M.S., et al. (2001). pH dependence of bone resorption: mouse
calvarial osteoclasts are activated by acidosis. Am J Physiol Endocrinol Metab 280(1): E112-
9. PMID: 11120665
Melton, L., Therneau, T., et al. (1998). Long-term trends in hip fracture prevalence: The
Influence of hip fracture incidence and survival. Osteoporos Int 8(1): 68-74.
Michaud, D.S., Troiano, R.P., et al. (2003). Comparison of estimated renal net acid
excretion from dietary intake and body size with urine pH. J Am Diet Assoc 103(8): 1001-7;
discussion 1007. PMID: 12891148
Minich, D.M., Bland, J.S. (2007). Acid-alkaline balance: role in chronic disease and
detoxification. Altern Ther Health Med 13(4): 62-5. PMID: 17658124
Morris, R. C., Jr., Schmidlin, O., et al. (1999). Differing effects of supplemental KCl and
KHCO3: pathophysiological and clinical implications. Semin Nephrol 19(5): 487-93. PMID:
10511388
Morselli, B., Neuenschwander, B., et al. (2000). [Osteoporosis diet]. Ther Umsch 57(3):
152-60. PMID: 10756695
Muhlbauer, R.C., Li, F. (1999). Effect of vegetables on bone metabolism. Nature 401(6751):
343-4. PMID: 10517630
Muhlbauer, R.C., Lozano, A., et al. (2002). Onion and a mixture of vegetables, salads, and
herbs affect bone resorption in the rat by a mechanism independent of their base excess. J
Bone Miner Res 17(7): 1230-6. PMID: 12096836
New, S.A., H.M. MacDonald, M.K. Campbell, et al. (2004). Lower estimates of net
endogenous non-carbonic acid production are positively associated with indexes of bone
health in premenopausal and perimenopausal women. Am J Clin Nutr 79: 131-138.
New, S. (2002). Bone health: nutritional and lifestyle factors. International Osteoporosis
Foundation World Congress on Osteoporosis.
New, S. (2004). Do vegetarians have a normal bone mass? Osteoporos Int 15(9): 679-88.
PMID 15258721
New, S., Millward, D. (2003). Calcium, protein and fruit and vegetables as dietary
determinants of bone health. Am J Clin Nutr 77(5): Letter to the Editor.
New, S. A., J. P. Banjour. (2003) Acid-base homeostasis and the skeleton: Is there a fruit
and vegetable link to bone health? In Nutritional aspects of bone health, ed. S. A. LanhamNew, J. P. Banjour. London: RSC Publishing, pp. 291-312.
New, S.A. (1999). Bone health: the role of micronutrients. Br Med Bull 55(3): 619-33.
PMID: 10746351
New, S.A. (2001). Exercise, bone and nutrition. Proc Nutr Soc 60(2): 265-74. PMID:
11681642New, S.A. (2002). Nutrition Society Medal lecture. The role of the skeleton in acid-base
homeostasis. Proc Nutr Soc 61(2): 151-64. PMID: 12133196
New, S.A. (2003). Intake of fruit and vegetables: implications for bone health. Proc Nutr
Soc 62(4): 889-99. PMID: 15018489
New, S.A., Bolton-Smith, C., et al. (1997). Nutritional influences on bone mineral density: a
cross-sectional study in premenopausal women. Am J Clin Nutr 65(6): 1831-9. PMID:
9174480
New, S.A., Robins, S.P., et al. (2000). Dietary influences on bone mass and bone
metabolism: further evidence of a positive link between fruit and vegetable consumption
and bone health? Am J Clin Nutr 71(1): 142-51. PMID: 10617959
Prynne, C.J., Ginty, F., et al. (2004). Dietary acid-base balance and intake of bone-related
nutrients in Cambridge teenagers. Eur J Clin Nutr 58(11): 1462-71. PMID: 15162137
Rahbar, A., B. Larijani, et al. (2009). Relationship among dietary estimates of net
endogenous acid production, bone mineral density and biochemical markers of bone
turnover in an Iranian general population. Bone 45(5):876-81.
Reddy, S.T., Wang, C. Y., et al. (2002). Effect of low-carbohydrate high-protein diets on
acid-base balance, stone-forming propensity, and calcium metabolism. Am J Kidney Dis
40(2): 265-74. PMID: 12148098
Remer, T. (2001). Influence of nutrition on acid-base balance—metabolic aspects. Eur J Nutr
Remer, T., F. Manz (1994). Estimation of the renal net acid excretion by adults consuming
diets containing variable amounts of protein. Am J Clin Nutr 59(6): 1356-61. PMID:
8198060
Remer, T., F. Manz (1995). Potential renal acid load of foods and its influence on urine pH. J
Am Diet Assoc 95(7): 791-7.
Riond, J. L. (2001). Animal nutrition and acid-base balance. Eur J Nutr 40(5): 245-54.
Sakhaee, K., N. M. Maalouf, et al. (2005). Effects of potassium alkali and calcium
supplementation on bone turnover in postmenopausal women. J Clin Endocrinol Metab
90(6): 3528-33. PMID: 15755853
Sebastian, A., Frassetto, L.A., et al. (2002). Estimation of the net acid load of the diet of
ancestral preagricultural Homo sapiens and their hominid ancestors. Am J Clin Nutr 76(6):
1308-16. PMID: 12450898
Sebastian, A., Harris, S.T., et al. (1994). Improved mineral balance and skeletal metabolism
in postmenopausal women treated with potassium bicarbonate. N Engl J Med 330(25):
1776-81. PMID: 8190153
Sellmeyer, D.E., M. Schloetter, et al. (2002). Potassium citrate prevents increased urine
calcium excretion and bone resorption induced by a high sodium chloride diet. J Clin
Endocrinol Metab 87(5): 2008-12. PMID: 11994333
Sellmeyer, D.E., K. L. Stone, et al. (2001). A high ratio of dietary animal to vegetable
protein increases the rate of bone loss and the risk of fracture in postmenopausal women.
Study of Osteoporotic Fractures Research Group. Am J Clin Nutr 73(1): 118-22. PMID:
11124760
Sprague, S.M., Krieger, N.S., et al. (1993). Aluminum inhibits bone nodule formation and
calcification in vitro. Am J Physiol 264(5 Pt 2): F882-90. PMID: 8498542
Sprague, S.M., Krieger, N.S., et al. (1994). Greater inhibition of in vitro bone mineralization
with metabolic than respiratory acidosis. Kidney Int 46(4): 1199-206. PMID: 7861717
Straub, B., Muller, M., et al. (2001). Osteoporosis and mild metabolic acidosis in the rat
after orchiectomy and their prevention: should prophylactic therapy be administered to
patients with androgen deprivation? J Urol 165(5): 1783-9. PMID: 11342976Street, D., Nielsen, J.J., et al. (2005). Metabolic alkalosis reduces exercise-induced acidosis
and potassium accumulation in human skeletal muscle interstitium. J Physiol 566: 481-89.
Triffitt, J. T., Terepka, A.R., et al. (1968). A comparative study of the exchange in vivo of
major constituents of bone mineral. Calcif Tissue Res 2(2): 165-76. PMID: 5705162
Trinchieri, A., Zanetti, G., et al. (2001). Effect of potential renal acid load of foods on
calcium metabolism of renal calcium stone formers. Eur Urol 39 Suppl 2: 33-6; discussion
36-7. PMID: 11223695
Tucker, K.L. (2003). Dietary intake and bone status with aging. Curr Pharm Des 9(32):
2687-704. PMID: 14529541
Tucker, K.L., Chen, H., et al. (2002). Bone mineral density and dietary patterns in older
adults: the Framingham Osteoporosis Study. Am J Clin Nutr 76(1): 245-52. PMID:
12081842
Tucker, K.L., Hannan, M.T., et al. (1999). Potassium, magnesium, and fruit and vegetable
intakes are associated with greater bone mineral density in elderly men and women. Am J
Clin Nutr 69(4): 727-36.
Tucker, K.L., Hannan, M.T., et al. (2001). The acid-base hypothesis: diet and bone in the
Tylavsky, F.A., Holliday, K., et al. (2004). Fruit and vegetable intakes are an independent
predictor of bone size in early pubertal children. Am J Clin Nutr 79(2): 311-7. PMID:
14749239
Vaitkevicius, H., Witt, R., et al. (2002). Ethnic differences in titratable acid excretion and
bone mineralization. Med Sci Sports Exerc 34(2): 295-302. PMID: 11828240
Vataparast, H., Jones, A.B., et al. (2005). Positive effects of vegetable and fruit
consumption and calcium intake on bone mineral accrual in boys during growth from
childhood to adolescence: the University of Saskatchewan Pediatric Bone Mineral Accrual
Study. Am J Clin Nutr 82(3): 700-6. PMID: 16155286
Wachman, A., Bernstein, D.S. (1968). Diet and osteoporosis. The Lancet 291: 958-959.
PMID: 4172759
Weiss, R. E., Gorn, A., et al. (1981). Influence of high protein diets on cartilage and bone
formation in rats. J Nutr 111(5): 804-16. PMID: 7229730
Whiting, S., Bell, J., et al. (2002). First Morning Urine Measured with pH Paper Strips
Reflects Acid Excretion. ASBMR Meetings Abstract, San Antonio, TX.
Wiederkehr, M., Krapf, R. (2001). Metabolic and endocrine effects of metabolic acidosis in
humans. Swiss Med Wkly 131(9-10): 127-32. PMID: 11416968
Wood, R.J. (1994). Potassium bicarbonate supplementation and calcium metabolism in
postmenopausal women: are we barking up the wrong tree? Nutr Rev 52(8 Pt 1): 278-80.
PMID: 7970292
Wynn, E., Lanham-New, S.A. et al. (2008). Low estimates of dietary acid load are positively
associated with bone ultrasound in women older than 75 years of age with a lifetime
fracture. J Nutr 138(7): 1349-54. PMID: 18567759
Wyshak, G., Frisch, R.E. (1994). Carbonated beverages, dietary calcium, the dietary
calcium/phosphorus ratio, and bone fractures in girls and boys. J Adolesc Health 15(3):
210-5. PMID: 8075091
Zhu, K., Devine, A., et al. (2009). The effects of high potassium consumption on bone
mineral density in a prospective cohort study of elderly postmenopausal women. Osteoporos
Int. 20(2):335-40.
Zwart, S.R., Hargens, A.R. et al. (2004). The ratio of animal protein intake to potassium
intake is a predictor of bone resorption in space flight analogues and in ambulatory
subjects. Am J Clin Nutr 80(4): 1058-65. PMID: 15447920
