Abnormalities in acid-base balance – dietary recommendations

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Acid-base homeostasis is a fundamental regulatory mechanism of the human body, vital for preserving optimal enzymatic kinetics and cellular functions. Modern dietary patterns, dominated by ultra-processed foods, refined grains, and excessive animal proteins, place substantial demands on physiological buffering systems within the blood, kidneys, and lungs. This comprehensive article explores the science of metabolic acid load, explains the Potential Renal Acid Load (PRAL) index, and delivers clinical nutrition strategies to support physiological balance.

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Acid-base homeostasis in the body

The body continuously undergoes various metabolic processes, the proper functioning of which depends on maintaining a stable acid-base balance in the internal environment. Blood, as the primary bodily fluid, exhibits the highest physico-chemical stability. An appropriate blood pH level enables the correct execution of biochemical processes. This balance is regulated by buffer systems, including the bicarbonate buffer, hemoglobin buffer, phosphate buffer, and protein buffers. Detoxification of the body primarily occurs through the kidneys and lungs, which expel excess carbon dioxide produced during the breakdown of proteins, carbohydrates, and fats, while urine eliminates excess acids and bases. A critical factor for the proper functioning of these processes is the stability of hydrogen ion concentration (pH): extracellular fluid 7.35–7.45, gastric juice 1.5, intestinal contents 8.0, urine 5.5–6.0.

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Acid-Base Imbalance Disorders

Acid-base imbalance encompasses two conditions: alkalosis and acidosis. Alkalosis occurs when hydrogen ion levels decrease, raising blood pH above 7.45. Types include metabolic alkalosis, resulting from excess bases or insufficient acid excretion, and respiratory alkalosis, caused by excessive CO2 elimination. Causes may involve vomiting, diarrhea, carbohydrate overconsumption, infections, dehydration, diuretic use, or respiratory disorders. Acidosis is a state where blood pH drops below 7.35. Types include respiratory acidosis, due to impaired CO2 excretion, and metabolic acidosis, resulting from excess acid production or inadequate excretion, such as lactic acidosis. Acidosis is more common and often linked to unhealthy lifestyle choices.

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Acid-base balance in the diet

A crucial factor in maintaining good health is a well-balanced diet. Food items contain various nutrients that impact the body's acid-base equilibrium, including calcium, magnesium, potassium, and sodium (which exhibit alkaline properties) as well as phosphorus, chlorine, and sulfur (which exhibit acidic properties). Consequently, it is vital to provide the body with sufficient alkaline foods such as milk and dairy products, fruits, vegetables, legumes, and acidic foods like grains, meat, poultry, fish, aged cheeses, and eggs. Additionally, maintaining the proper calcium-to-magnesium ratio (2:1) is essential. Disruption of this balance may result in osteoporosis and other health conditions.

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