Acid–Base Balance, Health and Diet

292 DOI: 10.1089/act.2009.15606 • MARY ANN LIEBERT, INC. • VOL. 15 NO. 6 ALTERNATIVE AND COMPLEMENTARY THERAPIESDECEMBER 2009

A number of scientists have theorized that a range of health problems result from a discordance between the modern diet and genetically determined chemical balances and nutritional requirements that evolved over millennia,1 effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet.1,2 This article reviews the effects on health of the body’s acid-base balance, questions about whether and how alkalinizing diets and alkalized water are beneficial for maintaining or restoring such homeostasis, and related clinical issues.

The Evolutionary Context

Until relatively recently on the evolutionary scale, hu-mans subsisted primarily on uncultivated plant foods. The modern diet has substituted sodium chloride (NaCl) in copious amounts for naturally occurring potassium alkali (K-base) salts, along with an increased consumption of meat, processed grains, and refined sugar, with potentially del-eterious effects on the body.2 Consequently, many other-wise-healthy contemporary humans may be suffering from chronic, diet-induced low-grade systemic metabolic acido-sis and its pathophysiologic sequelae. From an evolution-ary perspective, a low-grade metabolic alkalosis may be the optimal acid–base state.1

According to Susan E. Brown, Ph.D., C.C.N. (a medical anthropologist and New York State certified nutritionist, practicing as a bone-health nutritionist in East Syracuse), “[d]espite this understanding of the importance of pH in the maintenance of life, until recently, the mainstream med-ical establishment overlooked the existence of low-grade pH imbalances.”3

Regulation of pH

Literally meaning “potential for hydrogen,” pH was first de-fined in 1909 as the concentration of hydrogen ions in a fluid, expressed as moles per L. All acids give off hydrogen ions, whereas bases accept hydrogen ions. Because the hydrogen ion is highly unstable, acids and bases react with each other; the bicarbonate ion is the major base that neutralizes acids. For proper bodily functioning, a slightly alkaline arterial blood pH of 7.365–7.450 is considered normal (on a scale of 0–strongly acidic to 14–strongly base, with a pH of 7 being neutral). Even a slight deviation from the normal pH range can affect many bodily functions and organs adversely. The body uses multiple mechanisms, including the lungs, kidneys, and such buffer sys-tems as the sweat glands, to control the essential blood acid–base balance.3

Causes of Disturbed Acid–Base Homeostasis

Metabolic acidosis is defined as a disturbance in the body’s acid–base balance that results in excessive acidity of the blood. In the majority of mild chronic cases, overly acidic pH levels are diet-induced. Severe acute acidosis can result from various conditions. These conditions include diabetic ketoacidosis, renal failure, ingestion of excessive amounts of aspirin or certain toxic substances (e.g., anti-freeze), and shock. Diagnostic indicators of acidosis vary by condition.4 Acidosis can also result from disruption of normal gut function caused by gastrointestinal (GI) infec-tion, disease, or surgical complications.5

Clinically significant, subacute metabolic alkalosis (an ex-cessively base pH), which is less common and rarely related

Acid–Base Balance, Health, and Diet

Sala Horowitz, Ph.D.

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ALTERNATIVE AND COMPLEMENTARY THERAPIES • DECEMBER 2009

MARY ANN LIEBERT, INC. • VOL. 15 NO. 6

to diet, can be caused by excessive use of antacids or diuret-ics, chronic vomiting or diarrhea, overactivity of the adrenal glands, and living at high altitudes.3

Consequences of Disturbed Acid–Base Homeostasis

Acidosis and alkalosis are not diseases in themselves, but rather are imbalances indicative of underlying conditions. A typical acidogenic Western diet low in K-base–rich plant foods and high in acid-forming nutrients from animal protein in-creases the body’s net systematic acid load and may result in chronic, low-grade acidosis. Superphysiologic acid loads can result in kidney-stone formation, decreased muscle and boss mass in adults, and mental retardation in children. Death can even result in severe cases.1

Christopher Vasey, N.D., a naturopathic doctor, based near Montreux, Switzerland, has stated that chronic imbalance results in health problems, including fatigue, slowed down endocrine functioning (except in the thyroid), and suscep-tibility to respiratory and urinary-tract infection (UTI), by causing enzyme disturbances, aggressive activity by acids, and demineralization of bones.6 Chronic demineralization of bones can lead to osteoporosis, osteoarthritis (OA), and other bone-related conditions, which have been associated with animal protein–dominant, acid–base unbalanced diets, and lifestyles not conducive to bone health.3

Chronic low-grade acidosis can also contribute to prema-ture aging by impairing cellular-repair processes, accelerating muscle loss (by breaking down cells to derive the amino acid glutamine used in the manufacture of the base ammonia for deacidification), and cognitive decline.3

Methods of Food pH Analysis

Estimates of acid–base food impact were originally based on the concept of acid and alkaline ash. Foods were considered acidic if, when burned, their remaining ashes contained such acid-forming minerals as phosphorus, sulfur, and iodine. Foods were deemed alkaline if their ashes contained such minerals as calcium, magnesium, and potassium. A newer approach examines foods’ metabolic effects (i.e., the types of minerals, amino acids, and other compounds that the food contributed to the body after being metabolized). Formulas were created in

attempts to calculate the impact of the whole food—a daunting task given the complexity of metabolism.3

A further step in the evolution of quantifying foods’ impact on pH involved estimating the potential kidney-acid load of foods (i.e., the extent to which foods affect urine pH and urine acid excretion). This model enabled the development of food tables showing estimates of the acid- or alkaline-form-ing potential of many common foods. A simplified related strategy analyzed a food’s ratio of protein (the major dietary acidifying force) to potassium (the major dietary alkalizing force) to predict the amount of acid excreted by the kidneys

and thus, the amount of acid created by the metabolized food. Other formulas exist for quantifying the impact of foods on acid excretion.3

A Model of Acid–Base Chemistry

A quantitative model was developed by Canadian physi-ologist Peter A. Stewart, Ph.D. (1921–1993), to provide in-sights into the complex chemistry of acid–base equilibrium,7 which is beyond the scope of this paper.* The Stewart model has been influential in the understanding of the mechanisms of this metabolic balance and its imbalances,8 and in main-stream clinical practice,9 particularly in critical-care set-tings.10 Even practitioners who only perform surgery under local anesthesia need to be familiar with principles of the acid–base balance.11

Assessing pH Level

Measuring a patient’s pH level as an index of acid–base bal-ance can be conducted through blood, urine, and saliva tests. Each bodily fluid has a slightly different pH level; arterial blood has an average pH of 7.41, whereas urine pH can vary from 5 to 8 over the course of a day, depending on the nu-trients consumed.3 In critical care, metabolic acidosis can be diagnosed through one of several blood tests: an arterial blood test to assess severity; a complete blood count (CBC) to assess possible cause(s); and a metabolic panel to reveal the severity and cause of the condition.4

For assessing chronic low-grade metabolic acidosis in her patients, Dr. Brown utilizes a time-specific urine sample (i.e., a test that uses pH litmus paper with a first-in-the-morning

Acidosis and alkalosis are not diseases in themselves, but rather

are imbalances indicative of underlying conditions.

*The Stewart model is based on the same principles as more-traditional treatments of acid–base balance, but this mathematical approach treats pH in terms of independent and dependent variables. Bicarbonate and hydrogen ions are the dependent variables. They represent the effects rather than the cause of acid–base imbalances and are regulated by the independent variables in blood plasma of the partial pressure of CO2 (PCO2, the amount of CO2 gas dissolved in the blood), weak acids, and the strong ion difference. As PCO2 levels rise, blood pH levels decrease, making it more acidic; as PCO2 decreases, blood pH levels will rise, making it more alkaline.

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urine sample provided by patients at home) for initial assess-ment and subsequent monitoring. Dr. Brown suggests using test paper that measures pH with sufficiently small gradi-ents to detect the 6.5–7.5 pH range. For patients who can-not sleep for more than 6 hours without waking to urinate, a saliva test is an acceptable alternative. The normal range for a saliva sample taken the first thing in the morning, which may be higher than urine pH, is 6.5–7.5.3

Certain drugs can interfere with the accuracy of pH read-ings. For example, ammonium chloride, which is found in some cold and cough medications, may produce high acidic urine. Acetazolamide, which is used for treating glaucoma and other conditions, may produce a falsely high alkaline reading because this chemical forces the kidneys to excrete bicarbonate, which results in a lower blood pH. Conversely, imbalanced acid–alkaline levels can interfere with the effec-tiveness of some medications.3

Clinical Approaches to Achieving Acid–Base Balance

To achieve a consistently acidic pH level, Dr. Brown ad-vises her patients to make dietary modifications aimed at al-kalizing their diet. She recommends that 80% of each meal consist of alkalizing foods. When a patient’s pH level reaches the healthful range, a 60% alkaline to 40% acid ratio food diet is then recommended.3 Adjustment of tissue alkalinity through an alkalizing food-rich diet and appropriate supple-mentation can result in more-efficient metabolic detoxifica-tion and chronic-disease prevention.12

Robert O. Young, Ph.D., a microbiologist and nutritionist in Valley Center, California, applies principles of acid–base pH balance to treating types 1 and 2 diabetes. Chi C. Mao, M.D., Ph.D. (chief medical officer, Select Specialty Hospi-tals, Houston, Texas, at the time of publication), has likened this balance to the Traditional Chinese Medicine (TCM) concept of the balance of opposite life forces necessary for health.13

Herman Aihara (who died in 1998), a noted advocate for the macrobiotic diet, explicitly linked acid–base balance with the concepts of yin and yang and imbalances in both to health problems, including cancer.14 TCM recommends a diet rich in fresh vegetables and fruits, which are rich in bicarbonate precursors, to promote health and longevity.15

In two controlled studies (combined N = 30) conducted in 2002–2003, Dr. Young found that 20 patients (ages 10–61) who remained in either of the studies were able to control their diabetes through a strict alkaline diet, nutritional sup-plements, and aerobic exercise in 12 weeks following an ini-tial 1-week liquid fast. The regimen also resulted in weight loss, maintenance of normal blood sugar, lower blood pres-sure (BP), reduced total cholesterol, and significant reduc-tion in need for insulin or other diabetic medication (an 81% reduction for type 1 diabetes and 96% reduction for type 2 diabetes).13

Nutritional Therapy

FoodsIdeally, every meal should contain a balance of alkalizing

and acidifying nutrients. However, it is not always appar-ent which foods are acidifying or alkalizing. For example, although citrus fruits are chemically acidic, they have an alkalizing effect once they are metabolized, because a sig-nificant percentage of the citric and malic acids in these foods is converted into bicarbonate in the liver. However,

because orange juice also contains high amounts of alka-linizing potassium, this juice’s effect on raising urinary pH is much greater than that of lemonade, which is low in po-tassium.16 To complicate matters further, different forms of the same food can be categorized differently. For example, while miso (soybean paste) is highly alkaline-forming, other soy products, including soybeans and tofu (soybean curd), are considered highly acid-forming.3

It is important to note that different practitioners may classify foods somewhat differently in terms of their degree of acidity or alkalinity. Dr. Vasey has noted that the ripeness and processing of foods affect their acid and alkaline levels. For instance, unripe fruit is more acidic than ripe fruit. Although dairy products are generally classified as acidifying, raw whole milk, fresh unheated butter, and fresh soft unripened cheeses, such as well-drained cottage cheese, are considered alkalizing.6

Dr. Vasey has added a third category of foods to the al-kalizing and acidifying groups usually considered useful for maintaining a proper acid–alkaline balance: weak-acid foods, (i.e., foods that can increase the alkalinity of the blood by the abovementioned mechanism). Strong or stable acids, in contrast, come primarily from animal proteins and must be eliminated by the kidneys. Weak acids, also called volatile ac-ids, come primarily from plant foods containing unacetylated salicylic, citric, oxalic, or pyruvic acid. However, yogurt and whey are protein-based sources of weak acids. Plant-based sources listed by Dr. Vasey include unripe fruits, acid fruits (e.g., berries, citrus fruit), fruit juices, acidic vegetables (e.g., tomatoes, rhubarb, watercress), sauerkraut, lactofermented vegetables, lemon juice, vinegar, and honey.

Dr. Vasey considers weak acid foods particularly important for treating patients who, because of metabolic problems, cannot elim-inate weak acids through the usual route of respiration. Because “[t]he same food can have an entirely different effect depending on the body of the person who ingests it,” according to Dr. Vasey, diets for promoting a pH balance must be individualized.6

Russell M. Jaffe, M.D., Ph.D., C.C.N., of ELISA/ACT Biotechnologies LLC, in Sterling, Virginia, lists antibiotics as highly acidic.17 Other drugs that may have an acidifying effect

It is not always apparent which foods are acidifying or alkalizing.

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on the body include antihistamines, antiseptics, and nonsteroi-dal anti-inflammatory drugs (NSAIDS).3

Dr. Brown advises against eliminating all acidifying foods from the diet, because the body requires moderate amounts of protein in order to build and repair tissues, and even to establish and maintain reserves of alkaline minerals. Most fast foods, however, should be avoided because they are highly acidifying: They contain unhealthy fats, oils, and ad-ditives; are highly processed; and, consequently, are low in alkalizing minerals.3

SupplementsIn conjunction with a diet of fruits, vegetables, and

whole grains, alkalizing mineral and other supplements in the form of capsules, drops, or drinks can assist the body’s shift from hyperacidity to a healthier acid–alkaline balance. Dr. Brown recommends alkalizing supplements when diet alone does not achieve a balance and in cases when ex-tradietary factors such as stress lead to excessive depletion of minerals. She prescribes various supplements, including a mix of the alkalizing magnesium salts magnesium glyci-nate, magnesium ascorbate, and magnesium citrate. Alkal-izing green-vegetable juices, such as wheatgrass and barley, may also be beneficial.3

Dr. Vasey has likewise noted that dietary adjustments may be insufficient to eliminate accumulated acids, and, therefore, he recommends alkaline supplements to support and acceler-ate the body’s process of deacidification. The products he rec-ommends are typically a blend of five base minerals—calcium, potassium, magnesium, iron, and manganese—formulated to restore the body’s acid–base balance and other minerals and weak acids in an easily metabolizable form. Products that contain sodium are contraindicated for patients with hyper-tension. Dosage is individually tailored to each patient to re-store pH to a normal level.6

Other supplements that Dr. Vasey recommends for de-acidification include “green” foods (e.g., juices from chloro-phyll-rich green vegetables, cereal-grain sprouts, and com-mercially available green-food products), enzyme supple-ments, prebiotic and probiotic complexes, and antioxidant complexes. Patients whose diets lack in raw vegetables and are high in refined foods are likely to also be deficient in the enzymes needed to maintain a healthy acid–alkaline bal-ance. Examples of enzymes featured in commercial prod-ucts that Dr. Vesey considers useful for oxidizing acids in the body include bromelain, papain, trypsin, lipase, amylase, cellulase, and serrazimes.

In addition, preparations from medicinal plants that act as diuretics (e.g., teas from black current, cranberry juice), and methods of promoting elimination of acids through the skin (such as hydrothermal baths), may be beneficial. Dr. Vasey does not generally recommend fasting as an effective deacidification method. A detoxifying diet based on green foods and alkal-izing water is considered safe except for patients who cannot metabolize weak acids properly; other mono diets (those based on a single food) are not recommended.6

Exercise and Natural Therapies as Alkaline BoostersMichelle Schoffro Cook, D.N.M., D.Ac., C.N.C., a doctor

of natural medicine and acupuncture and holistic nutritionist in Ottawa, Canada, recommends exercise in conjunction with diet to act synergistically to reduce acid and increase alkaline to achieve a healthy pH balance. Dr. Cook has noted that exercise—in addition to its other well-known benefits—helps counter acidity in the body by accelerating elimination of ac-ids through sweat. Natural therapies, including deep breath-ing, meditation, massage, acupuncture, and saunas, “can shift the balance between the ‘tending and befriending’ hormone oxytocin and the ‘stressed out’ acidifying hormone cortisol.”18 In addition, slow, deep breathing depletes the body of carbon dioxide (CO2), which raises the body’s pH.

Research on Acid–Base Chemistry

Two recent randomized studies exemplify the complexity of acid–base chemistry in relation to diet. One, which was a placebo-controlled, double-blinded study, examined the ef-fect of an alkaline salt, potassium bicarbonate (KHCO3), on countering the negative impact of acidic byproducts of protein metabolism on the musculoskeletal system. Nineteen healthy older adults (ages 54–82) were given up to 90 mmol per L per day of KHCO3 or placebo for 41 days. The KHCO3 reduced the rise in 24-hour urinary nitrogen excretion that accompa-nied an increase in protein intake. The researchers concluded that KHCO3 may promote calcium absorption independent of dietary protein content, which has implications for older adults with declining renal function.19

The other randomized study examined calcium excretion and bone resorption in 171 healthy men and women, ages 50 and older. All subjects were given 600 mg of calcium (as triphosphate) and 525 international units (IU) of vitamin D3 daily. In this study, sodium bicarbonate, but not potas-sium supplementation (in the form of 67.5 mmol per day of potassium bicarbonate or potassium chloride), had positive

Table 1. Average Potential Renal Acid Loads (PRAL) of Selected Foods

Food PRAL (mEQ)*

Fruits, fruit juices –3.1

Vegetables –2.8

Fats, oils 0

Grain products 3.5–7.0

Fish 7.9

Meat, meat products 9.5

Milk, dairy products 1.0–23.6

Adapted from Ref. 12. *mEQ, milliequivalent per liter.

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effects on calcium excretion and bone resorption after 3 months. The researchers suggested that increasing the al-kali content of the diet may attenuate bone loss in healthy older adults.20

Water Alkalizers

According to Dr. Brown, drinking water is not generally a significant contributor to acidosis. In fact, mineral water high in dissolved bicarbonates and low in chloride is an effective means of countering chronic low-grade acidosis. She noted that one might need to contact the manufacturer of a product to find out that brand’s exact contents.3

Dr. Vasey’s recommendation is drinking alkaline spring wa-ter, alkalized tapwater, or distilled water treated to increase its alkalinity with commercially available alkaline preparations only until the individual’s acid–alkaline balance is restored, up to a maximum of 1 or 2 years.6

Advertisements have claims that water alkalizers (or wa-ter ionizers) promote immunity against disease, as well as assisting weight-loss, absorption of vitamins and minerals, and antiaging by transforming acidic or neutral tapwa-ter into alkaline water. Such products are said to work by producing high levels of negative hydroxyl ions. Patients should be advised to check with their clinicians before us-ing such products.

Relevant research supports the positive biologic effects of alkaline mineral water on bone metabolism. In a study of 30 females (average age 26.3) randomized to drink 1.5 L per day of either alkaline-rich water or water rich in calcium only, the subjects’ changes in blood and urine electrolytes, C-telepeptides (CTX), urinary pH and bicarbonate, and serum parathyroid hormone (PTH), were measured after 2 and 4 weeks. The subjects’ adhered to an identical bal-anced diet. The calcium-rich acidic water had no effect on bone resorption, while the bicarbonate-rich alkaline water resulted in a significant decrease of serum-CTX (S-CTX) and PTH.21

Another randomized study examined the effects of two drinking waters with similar calcium (Ca) concentration, to determine the role of ions other than Ca on bone metabolism

in 49 patients who remained in the study. These drinking waters differed in mineral composition with respect to con-centrations of bicarbonate (HCO3–) and sulfate. After the subjects drank 1 L per day, for 28 days, of one type of water, and a crossover to the alternate type of water for a further 28

days, changes in Ca metabolism and positive action on bone metabolism were significant in the high-base group com-pared with baseline.22

Water that has been alkalized during ionization has been shown to produce active hydrogen to counter the active oxygen or free radicals that cause oxidative damage to DNA.23

Conclusion

Given that acid–base balance is so essential to optimal health, foods and supplements that promote this equilibrium should be a high priority in health care and in consumers’ di-ets. The health costs of the contemporary, highly acidifying standard Western diet are clear. Studies on claims regarding products for alkalizing water are warranted in light of research that suggests the positive effects of alkaline drinking water on bone metabolism. Patients should always check with a health practitioner before going on any diet intended to affect acid–base balance. n

References

1. Frassetto L, Morris RC Jr, Sellmeyer DE, et al. Diet, evolution and aging—the pathophysiologic effects of the post-agricultural inversion of the potas-sium-to-sodium and base-to-chloride ratios in the human diet. Eur J Nutr 2001;40:200–213.2. Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the West-ern diet: Health implications for the 21st century. Am J Clin Nutr 2005;81: 341–354.3. Brown SE, Trivieri L. The Acid Alkaline Food Guide: A Quick Reference to Foods & Their Effect on pH Levels. Garden City Park, NY: Square One Publishers, 2006.4. MedlinePlus. Medical Encyclopedia: Metabolic Acidosis. Online docu-ment at: www.nlm.nih.gov/medlineplus/print/ency/article/000335.htm Ac-cessed June 18, 2009.5. Gennari FJ, Weiss WJ. Acid–base disturbances in gastrointestinal disease. Clin J Am Soc Nephrol 2008;3:1861–1868.6. Vasey C. Acid-Alkaline Diet for Optimum Health: Restore Your Health by Creating pH Balance in Your Diet, 2nd rev. ed. Rochester, VT: Healing Arts Press, 2006.7. University of Pittsburgh Department of Critical Care Medicine. Welcome to Acid Base pHorum! Online document at: www.ccm.upmc.edu/education/resources/phorum.html Accessed November 25, 2009.

Recommended Reading

For practitioners

Stewart’s Textbook of Acid–Base, 2nd ed. Edited by John A. Kellum, M.D. and Paul W.G. Elbers, M.D. Raleigh, NC: Lulu.com, 2009

For practitioners and patients

The Acid Alkaline Food Guide: A Quick Reference to Foods & Their Effect on pH Levels By Susan E. Brown, Ph.D., and Larry Trivieri, Jr. Garden City Park, NY.: Square One Publishers, 2006

The health costs of the contemporary, highly acidifying standard

Western diet are clear.

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8. Rehm M, Conzen PF, Peter K, Finesterer U. The Stewart model. “Mod-ern” approach to the interpretation of the acid-base metabolism [in German]. Anesthetist 2004;53:347-357.9. Doberer D, Funk GC, Kirchner K, Schneeweiss B. A critique of Stewart’s approach: The chemical mechanism of dilutional acidosis. Intensive Care Med 2009;June 17:e-pub ahead of print.10. Wooten EW. Science review: Quantitative acid-base physiology using the Stewart model. Critical Care 2004;8:448–452. 11. Shiffman MA. Acid–base balance: Biochemistry for all surgeons [review]. Int J Cosmetic Aesthetic Dermatol 2001;3:17–18. 12. Minich DM, Bland JS. Acid –alkaline balance: Role in chronic disease and detoxification. Altern Ther Health Med 2007;13:62–65.13. Young RO; Mao CC, Foreword. The pH Miracle for Diabetes: The Revolution-ary Diet Plan for Type 1 and Type 2 Diabetes. New York: Warner Books, 2004.14. Aihara H. Acid and Alkaline, 5th ed. Oroville, CA: George Ohsawa Mac-robiotic Foundation, 1986.15. Matesz D. Achieving Acid–Base Balance. Acupuncture Today. Online document at: www.acupuncturetoday.cm/archives2003/jul/07matesz.html Accessed June 23, 2009.16. Odvina CV. Comparative value of orange juice versus lemonade in reduc-ing stone-forming risk. Clin J Am Soc Nephrol 2006;1:1269–1274.17. Jaffe RM. Food & Chemical Effects of Acid/Alkaline Body Chemical Bal-ance. Online document at: www.elisaact.com/pdfs/EABAcidAlka_neChart_FINAL.pdf Accessed July 1, 2009.

18. Cook MS. The Ultimate pH Solution: Balance Your Body Chem-istry to Prevent Disease and Lose Weight. New York: HarperCollins, 2008.19. Ceglia L, Harris SS, Abrams SA, et al. Potassium carbonate attenu-ates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption. J Clin Endocrinol Metab 2009;94:645–653.20. Dawson-Hughes B, Harris SS, Palermo NJ, et al. Treatment with potas-sium carbonate lowers calcium excretion and bone resorption in older men and women. J Clin Endocrinol Metab 2009;94:96–102.21. Wynn E, Krieg MA, Aeschlimann JM, et al. Alkaline mineral water lowers bone resorption even in calcium sufficiency: Alkaline mineral water and bone metabolism. Bone 2009;44:120–124.22. Roux S, Baudoin C, Boute D, et al. Biological effects of drinking-water mineral composition on calcium balance and bone remodeling markers. J Nutr Health Aging 2004;8:380–384.23. Shirahata S, Kabayama S, Nakano M, et al. Electrolyzed-reduced water scavenges active oxygen species and protects DNA from oxidative damage. Biochem Biophys Res Comm 1997;234:269–274.

To order reprints of this article, e-mail Karen Ballen at: [email protected] or call (914) 740-2100.

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Acid–Base Balance, Health and Diet

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