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Alkaline diet (also known as the alkaline ash diet, alkaline acid diet, acid ash diet, and acid alkaline diet) describes a group of loosely related diets based on the misconception that different types of food can have an effect on the pH balance of the body. It originated from the
acid ash hypothesis The acid-ash hypothesis is a medical hypothesis which suggests that excessively acidic diets may result in a number of identifiable health effects, including an increased risk of osteoporosis. It has received some attention in the lay community, and ...
, which primarily related to
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone ...
research. Proponents of the diet believe that certain foods can affect the
acidity In computer science, ACID ( atomicity, consistency, isolation, durability) is a set of properties of database transactions intended to guarantee data validity despite errors, power failures, and other mishaps. In the context of databases, a sequ ...
( pH) of the body and that the change in pH can therefore be used to treat or prevent disease. However, their claims are false, and there is no evidence supporting the claimed mechanisms of this diet, which is not recommended by
dietitian A dietitian, medical dietitian, or dietician is an expert in identifying and treating disease-related malnutrition and in conducting medical nutrition therapy, for example designing an enteral tube feeding regimen or mitigating the effects of ca ...
s or other
health professional A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...
s. The "acid-ash" hypothesis claimed that excess dietary production of acid was a risk factor for
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone ...
, but the scientific evidence does not support this hypothesis.


Alternative medicine

Alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and alt ...
practitioners who have promoted the alkaline diet have advocated its use in the treatment of various medical conditions, including
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
. These claims have been mainly promoted on
websites A website (also written as a web site) is a collection of web pages and related content that is identified by a common domain name and published on at least one web server. Examples of notable websites are Google, Facebook, Amazon, and Wiki ...
,
magazines A magazine is a periodical publication, generally published on a regular schedule (often weekly or monthly), containing a variety of content. They are generally financed by advertising, purchase price, prepaid subscriptions, or by a combination ...
,
direct mail Advertising mail, also known as direct mail (by its senders), junk mail (by its recipients), mailshot or admail (North America), letterbox drop or letterboxing (Australia) is the delivery of advertising material to recipients of postal mail. The d ...
, and
books A book is a medium for recording information in the form of writing or images, typically composed of many pages (made of papyrus, parchment, vellum, or paper) bound together and protected by a cover. The technical term for this physical ar ...
, and have been mainly directed at a lay audience. This version of the diet, in addition to avoiding meats and other proteins, also advocates avoiding processed foods, white sugar, white flour, and caffeine, and can involve specific exercise and nutritional supplement
regimen A regimen is a plan, or course of action such as a Diet (nutrition), diet, exercise or medical treatment. A salt#Health effects, low-salt diet is a regimen. A course of penicillin is a regimen, and there are many chemotherapy regimens in the treat ...
s as well. A version of this diet has also been promoted by Robert O. Young as a method of
weight loss Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other conn ...
in his book ''The pH Miracle''. According to the
Academy of Nutrition and Dietetics The Academy of Nutrition and Dietetics is a 501(c)(6) trade association in the United States. With over 112,000 members, the association claims to be the largest organization of food and nutrition professionals. It has registered dietitian n ...
, portions of his diet such as the emphasis on eating green leafy vegetables and
exercise Exercise is a body activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic ...
would likely be healthy. However, the "obscure theory" on which his diet is based and the reliance on complicated
fasting Fasting is the abstention from eating and sometimes drinking. From a purely physiological context, "fasting" may refer to the metabolic status of a person who has not eaten overnight (see " Breakfast"), or to the metabolic state achieved after ...
regimens and
nutritional supplements A dietary supplement is a manufactured product intended to supplement one's diet by taking a pill, capsule, tablet, powder, or liquid. A supplement can provide nutrients either extracted from food sources or that are synthetic in order ...
means that this diet "is not a healthy way to lose weight." It has also been proposed that acid causes
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involv ...
and
osteoarthritis Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the w ...
, and that an alkaline diet can be used to treat these conditions. There is no evidence to support this proposal. Urinary and/or
saliva Saliva (commonly referred to as spit) is an extracellular fluid produced and secreted by salivary glands in the mouth. In humans, saliva is around 99% water, plus electrolytes, mucus, white blood cells, epithelial cells (from which DNA can be ...
testing for acidity has been proposed as a way to measure the body's acidity level and therefore the level of risk for diseases. However, there is no correlation between the urinary pH and the acidity of the body.


Adverse effects

Because the alkaline diet promotes excluding certain families of foods, it could result in a less balanced diet with resulting nutrient deficiencies such as
essential fatty acids Essential fatty acids, or EFAs, are fatty acids that humans and other animals must ingest because the body requires them for good health but cannot synthesize them. Only two fatty acids are known to be essential for humans: alpha-linolenic ac ...
and
phytonutrients Phytochemicals are chemical compounds produced by plants, generally to help them resist fungi, bacteria and plant virus infections, and also consumption by insects and other animals. The name comes . Some phytochemicals have been used as poison ...
. Many websites and books promoting this diet sell courses of supplements and foods which are unnecessary to purchase even under the diet's own terms. The level of effort needed to use this diet is considered "high" as there are many foods that need to be excluded.


Proposed mechanism

According to the traditional
acid ash hypothesis The acid-ash hypothesis is a medical hypothesis which suggests that excessively acidic diets may result in a number of identifiable health effects, including an increased risk of osteoporosis. It has received some attention in the lay community, and ...
underlying this diet, acid ash is produced by meat, poultry, cheese,
fish Fish are aquatic, craniate, gill-bearing animals that lack limbs with digits. Included in this definition are the living hagfish, lampreys, and cartilaginous and bony fish as well as various extinct related groups. Approximately 95% of li ...
,
eggs Humans and human ancestors have scavenged and eaten animal eggs for millions of years. Humans in Southeast Asia had domesticated chickens and harvested their eggs for food by 1,500 BCE. The most widely consumed eggs are those of fowl, especial ...
, and grains. Alkaline ash is produced by fruits and vegetables, except cranberries, prunes and plums. Since the acid or alkaline ash designation is based on the residue left on combustion rather than the acidity of the food, foods such as citrus fruits that are generally considered acidic are actually considered alkaline producing in this diet. Advocates propose that since the normal pH of the blood is slightly alkaline, the goal of diet should be to mirror this by eating a diet that is alkaline producing as well. These advocates propose that diets high in acid-producing elements will generally lead the body to become acidic and thereby foster disease. because it is "virtually impossible" to create a less acidic environment in the body. While a selectively alkaline diet may change the pH level in the urine, it has not been shown to elicit a sustained change in blood pH levels, nor to provide the clinical benefits claimed by its proponents. Because of the body's natural regulatory mechanisms, which do not require a special diet to work, eating an alkaline diet can, at most, change the blood pH minimally and transiently. A similar proposal by those advocating this diet suggests that cancer grows in an acidic environment, and that an alkaline diet can change the environment of the body to treat cancer. However, contrary to the premise of the proposal, it is rapid growth of cancer cells that creates acidic environment associated with cancer; the acidic environment does not create cancer. "Extreme" dietary plans such as this diet have more risks than benefits for patients with cancer.


Evaluation

The British Dietetic Association named the alkaline diet one of the "top 5 worst celeb diets to avoid in 2018", branding it as "nonsense". This proposed mechanism, in which the diet can significantly change the acidity of the blood, goes against "everything we know about the chemistry of the human body" and has been called a "myth" in a statement by the
American Institute for Cancer Research The American Institute for Cancer Research (AICR) is a large American cancer research organization associated with the World Cancer Research Fund umbrella organization An umbrella organization is an association of (often related, industry-spec ...
Update 2 November 2020. While it has been proposed that this diet can help increase energy, lose weight, and treat cancer and
heart disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, hea ...
, there is no evidence to support any of these claims. The diet is not recommended by
dietitian A dietitian, medical dietitian, or dietician is an expert in identifying and treating disease-related malnutrition and in conducting medical nutrition therapy, for example designing an enteral tube feeding regimen or mitigating the effects of ca ...
s or other
health professional A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...
s. These diets have been promoted by
alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and alt ...
practitioners, who propose that such diets treat or prevent
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
,
heart disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, hea ...
, low energy levels, and other illnesses. Human blood is maintained between pH 7.35 and 7.45 by
acid–base homeostasis Acid–base homeostasis is the homeostatic regulation of the pH of the body's extracellular fluid (ECF). The proper balance between the acids and bases (i.e. the pH) in the ECF is crucial for the normal physiology of the body—and for cellu ...
mechanisms. Levels above 7.45 are referred to as
alkalosis Alkalosis is the result of a process reducing hydrogen ion concentration of arterial blood plasma (alkalemia). In contrast to acidemia (serum pH 7.35 or lower), alkalemia occurs when the serum pH is higher than normal (7.45 or higher). Alkalosis ...
and levels below 7.35 as
acidosis Acidosis is a process causing increased acidity in the blood and other body tissues (i.e., an increase in hydrogen ion concentration). If not further qualified, it usually refers to acidity of the blood plasma. The term ''acidemia'' describes ...
. Both are potentially serious. The idea that these diets can materially affect blood pH for the purpose of treating a range of diseases is not supported by scientific research and makes incorrect assumptions about how alkaline diets function that are contrary to human
physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
. While diets avoiding
meat Meat is animal flesh that is eaten as food. Humans have hunted, farmed, and scavenged animals for meat since prehistoric times. The establishment of settlements in the Neolithic Revolution allowed the domestication of animals such as chic ...
,
poultry Poultry () are domesticated birds kept by humans for their eggs, their meat or their feathers. These birds are most typically members of the superorder Galloanserae (fowl), especially the order Galliformes (which includes chickens, quails, a ...
,
cheese Cheese is a dairy product produced in wide ranges of flavors, textures, and forms by coagulation of the milk protein casein. It comprises proteins and fat from milk, usually the milk of cows, buffalo, goats, or sheep. During production, ...
, and
grain A grain is a small, hard, dry fruit (caryopsis) – with or without an attached hull layer – harvested for human or animal consumption. A grain crop is a grain-producing plant. The two main types of commercial grain crops are cereals and legum ...
s can be used in order to make the urine more alkaline (higher pH), difficulties in effectively predicting the effects of these diets have led to
medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...
s, rather than diet modification, as the preferred method of changing urine pH. The "acid-ash" hypothesis was once considered a risk factor for
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone ...
, though the current weight of scientific evidence does not support this hypothesis.


History

The role of the diet and its influence on the acidity of urine has been studied for decades, as physiologists have studied the
kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blood ...
's role in the body's regulatory mechanisms for controlling the acidity of body fluids. The French biologist
Claude Bernard Claude Bernard (; 12 July 1813 – 10 February 1878) was a French physiologist. Historian I. Bernard Cohen of Harvard University called Bernard "one of the greatest of all men of science". He originated the term '' milieu intérieur'', and the ...
provided the classical observation of this effect when he found that changing the diet of rabbits from an
herbivore A herbivore is an animal anatomically and physiologically adapted to eating plant material, for example foliage or marine algae, for the main component of its diet. As a result of their plant diet, herbivorous animals typically have mouthpart ...
(mainly plant) diet to a
carnivore A carnivore , or meat-eater (Latin, ''caro'', genitive ''carnis'', meaning meat or "flesh" and ''vorare'' meaning "to devour"), is an animal or plant whose food and energy requirements derive from animal tissues (mainly muscle, fat and other sof ...
(mainly meat) diet changed the
urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excretion, excreted from the body through the urethra. Cel ...
from more alkaline to more acid. Spurred by these observations, subsequent investigations focused on the chemical properties and acidity of constituents of the remains of foods combusted in a bomb calorimeter, described as
ash Ash or ashes are the solid remnants of fires. Specifically, ''ash'' refers to all non-aqueous, non- gaseous residues that remain after something burns. In analytical chemistry, to analyse the mineral and metal content of chemical samples, ash ...
. The "dietary ash hypothesis" proposed that these foods, when
metabolized Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
, would leave a similar "acid ash" or "alkaline ash" in the body as those
oxidized Redox (reduction–oxidation, , ) is a type of chemical reaction in which the oxidation states of substrate change. Oxidation is the loss of electrons or an increase in the oxidation state, while reduction is the gain of electrons or a ...
in
combustion Combustion, or burning, is a high-temperature exothermic redox chemical reaction between a fuel (the reductant) and an oxidant, usually atmospheric oxygen, that produces oxidized, often gaseous products, in a mixture termed as smoke. Combusti ...
. Nutrition scientists began to refine this hypothesis in the early 20th century, emphasizing the role of negatively charged particles (
anion An ion () is an atom or molecule with a net electrical charge. The charge of an electron is considered to be negative by convention and this charge is equal and opposite to the charge of a proton, which is considered to be positive by convent ...
s) and positively charged particles (
cation An ion () is an atom or molecule with a net electrical charge. The charge of an electron is considered to be negative by convention and this charge is equal and opposite to the charge of a proton, which is considered to be positive by convent ...
s) in food. Diets high in
chloride The chloride ion is the anion (negatively charged ion) Cl−. It is formed when the element chlorine (a halogen) gains an electron or when a compound such as hydrogen chloride is dissolved in water or other polar solvents. Chloride salts ...
,
phosphate In chemistry, a phosphate is an anion, salt, functional group or ester derived from a phosphoric acid. It most commonly means orthophosphate, a derivative of orthophosphoric acid . The phosphate or orthophosphate ion is derived from phospho ...
and
sulfate The sulfate or sulphate ion is a polyatomic anion with the empirical formula . Salts, acid derivatives, and peroxides of sulfate are widely used in industry. Sulfates occur widely in everyday life. Sulfates are salts of sulfuric acid and many ar ...
(all of which are anions) were presumed to be acid forming, while diets high in
potassium Potassium is the chemical element with the symbol K (from Neo-Latin ''kalium'') and atomic number19. Potassium is a silvery-white metal that is soft enough to be cut with a knife with little force. Potassium metal reacts rapidly with atmosphe ...
,
calcium Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to ...
and
magnesium Magnesium is a chemical element with the symbol Mg and atomic number 12. It is a shiny gray metal having a low density, low melting point and high chemical reactivity. Like the other alkaline earth metals (group 2 of the periodic ta ...
(all of which are cations) were presumed to be alkaline forming. Other investigations showed specific foods, such as
cranberries Cranberries are a group of evergreen dwarf shrubs or trailing vines in the subgenus ''Oxycoccus'' of the genus ''Vaccinium''. In Britain, cranberry may refer to the native species ''Vaccinium oxycoccos'', while in North America, cranberry ...
,
prunes A prune is a dried plum, most commonly from the European plum (''Prunus domestica''). Not all plum species or varieties can be dried into prunes. A prune is the firm-fleshed fruit (plum) of ''Prunus domestica'' varieties that have a high sol ...
and
plums A plum is a fruit of some species in ''Prunus'' subg. ''Prunus'.'' Dried plums are called prunes. History Plums may have been one of the first fruits domesticated by humans. Three of the most abundantly cultivated species are not found i ...
had unusual effects on urine pH. While these foods provided an alkaline ash in the laboratory, they contain a weak organic acid,
hippuric acid Hippuric acid ( Gr. ''hippos'', horse, ''ouron'', urine) is a carboxylic acid and organic compound. It is found in urine and is formed from the combination of benzoic acid and glycine. Levels of hippuric acid rise with the consumption of phenol ...
, which caused the urine to become more acidic instead.


Historical uses of alkaline diets

Historically, the medical application of alkaline diets largely focused on preventing recurrence of
kidney stone Kidney stone disease, also known as nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material (kidney stone) develops in the urinary tract. Kidney stones typically form in the kidney and leave the body in the urine s ...
s as well as the prevention of recurrent
urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...
s, by relying on the recognized ability of such diets to affect urinary pH. Years ago, such a diet was used to adjust the acidity of the urinary environment that the stones formed in, and could hypothetically help prevent stones from forming or the development of UTIs. However, the analytical methods that attempted to calculate the effects of food on urinary pH were not precise except in very general terms, making effective use of such diets difficult. Therefore,
medications A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and rel ...
, which can more reliably alter the urine pH, rather than diet modification, have been the treatment of choice when trying to alter urine pH. While there have been recent improvements in recognizing different variables that can affect acid
excretion Excretion is a process in which metabolic waste is eliminated from an organism. In vertebrates this is primarily carried out by the lungs, kidneys, and skin. This is in contrast with secretion, where the substance may have specific tasks after ...
in the urine, the level of detail needed to predict the urinary pH based on diet is still daunting. Precise calculations require very detailed knowledge of the nutritional components of every meal as well as the rate of absorption of nutrients, which can vary substantially from individual to individual, making effective estimation of urine pH not currently feasible.


See also

*
List of ineffective cancer treatments This is a non-exhaustive list of alternative treatments that have been promoted to treat or prevent cancer in humans but which lack scientific and medical evidence of effectiveness. In many cases, there is scientific evidence that the alleged tr ...
* D. C. Jarvis – Advocated higher blood acidity as prevention and treatment * Hay diet *
List of diets An individual's diet is the sum of food and drink that one habitually consumes. Dieting is the practice of attempting to achieve or maintain a certain weight through diet. People's dietary choices are often affected by a variety of factors, incl ...


References


External links

* *
About alkaline diets
on ScienceBlogs {{DEFAULTSORT:Alkaline Diet Acid–base physiology Alternative medical treatments Fad diets