Alkaline Cleanse and Detox: What's Really Behind "Over-Acidity"
A cheese sandwich does not make your blood acidic. Still, the alkaline feeling has a valid core. Here we separate the two: the myth of over-acidity and what a plant-forward diet can do for your kidneys, your blood pressure and your metabolism.
Few health promises are as widespread as the one about over-acidity. And few cause so many people needless worry. Your body is not a barrel of acid you have to empty. It is a control loop that works for you every second. Once you understand that, little of the myth remains. And quite a lot of the healthy core.
I bet you know this moment. Morning, bathroom, a small test strip. It turns yellow. And somewhere in your head a sentence pops up: "I'm over-acidic."
Maybe you are tired, have joint pain or simply feel heavy. Then an alkaline cleanse sounds like an explanation and a solution at once. Flush out the acid, stir in alkaline powder, take an alkaline bath, and the weight on your shoulders gets lighter.
I understand this need very well. It is the wish to finally have a reason for that vague sense of unwellness. And a lever you can pull yourself. That wish is legitimate. Only the explanation usually offered for it does not hold up to physiology.
In this text we take a close look. First at how strictly your body guards its blood pH. Then at what the test strip measures. After that at the studies on bone, cancer, diabetes and kidneys. And finally at the part of the alkaline idea that can be worth it for you.
Your blood pH: a value that doesn't negotiate
Thesis: With healthy lungs and kidneys, your body keeps blood pH between 7.35 and 7.45, no matter what you eat.
Imagine a thermostat so sensitive that it corrects a deviation of a tenth of a degree. That is roughly how your acid-base balance works. The normal range is tiny: 7.35 to 7.45. Even small deviations beyond it affect how enzymes work, how oxygen is released and how heart and nerves respond.
That is why evolution did not entrust this value to a single system, but to three. They work at different speeds, like a fire service with first responders, a fire engine and a rebuilding crew.
Blood buffers
SecondsBicarbonate, proteins and phosphate capture acid immediately, like a sponge soaking up water.
Lungs
MinutesBuffered acid turns into carbon dioxide. You breathe it out, usually without noticing.
Kidneys
Hours to daysThey excrete acid for good and generate new bicarbonate. This is the long-term balance.
A nephrology group at Tulane University described how the kidneys control the metabolic part of acid-base balance. They reclaim almost all filtered bicarbonate and generate new bicarbonate by excreting acid, largely as ammonium. For you, this means: your kidneys have enormous reserve capacity, and the acid from your food is exactly what they are built for.
DOI: 10.2215/CJN.07400715When the blood does become acidic
True acidification of the blood does exist. It is called acidosis. But it does not come from a steak or too much coffee. It happens when one of the three systems seriously fails or is overwhelmed.
Two nephrologists from Los Angeles and Boston summarized metabolic acidosis in Nature Reviews Nephrology. Acute forms usually result from an overproduction of acids such as ketoacids or lactic acid, chronic forms often from reduced acid excretion by the kidneys. For you, this means: true acidosis is a finding from blood gas analysis and lab values, often in uncontrolled diabetes, severe infections or kidney disease, and it belongs in medical care, not in a cleanse.
DOI: 10.1038/nrneph.2010.33If your blood really were over-acidic, you would not just feel tired. You would breathe fast and deep, because your lungs would be desperately trying to get rid of carbon dioxide, and you would need a hospital. The feeling of heaviness in everyday life almost always has other causes, and they deserve to be looked for seriously.
And now you know why "blood made acidic by diet" in healthy people is a description that, physiologically, does not exist in that form.
What the test strip measures, and what it doesn't
Thesis: Urine pH shows how much acid your kidneys are excreting right now. It does not show how acidic your body is.
Back to the bathroom. The yellow strip is not a measurement error. Your urine really is rather acidic this morning. The only question is what that means.
Think of a household waste bin. When it is full, that does not mean your apartment is full of trash. It means the waste collection is working. Urine is exactly the same. Acidic urine shows that your kidneys are carrying the acid from metabolism out of your body.
Tightly regulated, not measurably shifted by diet in healthy people. A deviation is a medical finding.
Reflects meals, time of day and the excretory work of the kidneys. Moves across a wide range depending on what you eat.
In 1995, Thomas Remer and Friedrich Manz of the Research Institute of Child Nutrition in Dortmund calculated the potential renal acid load, PRAL for short, of common foods. Hard cheese reached up to about 24 milliequivalents per 100 grams, fats and oils about zero, fruit, juices and vegetables an average of about minus 3. Net acid excretion was closely linked to urine pH, and that is exactly what your test strip shows: your last meal, not your blood.
DOI: 10.1016/S0002-8223(95)00219-7Acid load of selected food groups (PRAL, simplified)
Values in milliequivalents per 100 grams according to Remer and Manz 1995. Positive means acid-forming for the kidneys, negative means base-forming. This says something about the work of the kidneys, not about blood pH.
What's interesting is that lemons end up on the alkaline side here. They taste sour, but their organic acids are metabolized, and what remains are minerals such as potassium that the body can use to form bicarbonate. Taste and acid load are two different things.
A yellow strip every morning almost never points to a disturbance of acid-base balance. Often there is exhaustion behind it, looking for a tangible reason. Looking at sleep, iron, thyroid, blood sugar or stress can make more sense. That is less simple than a strip, but it leads to places where something can actually shift.
Acidic morning urine is not an alarm signal. It is more like evidence that your kidneys worked overnight. The strip measures the waste collection, not the state of the apartment.
And now you know why you can safely put the test strip away without missing anything important.
Bones, cancer, alkaline water: what the studies show
Thesis: For the big promises of the alkaline idea, bone protection and cancer prevention, the evidence is still missing.
The classic story sounds logical. An acid-rich diet forces the body to pull calcium from the bones to buffer acid. Over time, the bones would become porous. This model is called the acid-ash hypothesis. It is elegant. And it has been tested thoroughly.
Tanis Fenton and colleagues at the University of Calgary pooled methodologically high-quality calcium balance studies; five of sixteen met the strict criteria. More acid excretion did mean more calcium in the urine, but whole-body calcium balance did not change, and a marker of bone breakdown remained unaffected as well. For you, this means: more calcium in your urine is not automatically calcium your bones are missing.
DOI: 10.1359/jbmr.090515Two years later, the same group examined 55 studies against Hill's criteria for causality, including 22 randomized interventions. They found no evidence of a causal link between acid load and osteoporosis and no evidence that an alkaline diet protects bone. For you, this means: if you are worried about your bones, movement, strength, vitamin D, protein and hormone status are the better-supported levers.
DOI: 10.1186/1475-2891-10-41The chapter is not entirely closed, though. And honesty requires saying so.
In 2021, a research group from Guangzhou analyzed 13 randomized trials each on acid-forming diets and on alkaline supplements. Acid-forming diets increased acid and calcium excretion but changed neither bone turnover markers nor bone density. Alkaline supplements, by contrast, were associated with slightly higher bone density, although the authors explicitly urge caution and call for larger studies.
DOI: 10.1093/advances/nmab002Alkaline water and cancer
The promise goes even further when it claims an alkaline diet or alkaline water could prevent cancer or even stop it. Here the evidence is clearly thin.
In 2016, Tanis Fenton and Tian Huang screened more than 8,000 citations in BMJ Open. What remained was a single usable study, a cohort study on bladder cancer that found no significant association with acid load; there were no randomized trials. The authors consider the public promotion of alkaline diets and alkaline water for cancer prevention or cancer treatment unjustified.
DOI: 10.1136/bmjopen-2015-010438"Acid pulls calcium out of your bones."
More calcium in the urine, yes. A loss of bone mass could not be shown in balance studies.
Open question on supplements
In one meta-analysis, alkaline supplements show hints of slightly higher bone density. Not yet a reason to experiment on yourself.
"Alkaline water protects against cancer."
There is almost no research on this. Water you drink does not change blood pH.
The stomach is acidic, the blood stable
Alkaline water first meets stomach acid. After that, buffers, lungs and kidneys take over.
"Not supported" does not mean here that vegetables are useless. It means the reasoning was chosen wrongly. If you eat broccoli to de-acidify your bones, you are doing something good for the wrong reason. That is no drama. But it is worth knowing the right reason, so you don't pay for powders and water filters that contribute nothing.
And now you know why the big alkaline promises have little substance when you look closely.
The valid core: acid load, potassium and vegetables
Thesis: Not your blood, but your kidneys feel the difference between a low-vegetable and a plant-forward diet.
Up to here, much of this sounded like an all-clear. Now comes the part where the alkaline idea touches on something true. It is quieter than the marketing, but it is more interesting.
Your blood stays stable. But someone has to do the work for that. Every meal with plenty of animal protein and few vegetables hands your kidneys a portion of acid they have to excrete. Every meal with plenty of vegetables brings them potassium and organic anions from which bicarbonate can be formed. It is like the difference between headwind and tailwind on a bike. You arrive either way. The question is how much effort it takes.
Lynda Frassetto and colleagues at the University of California, San Francisco measured the kidneys' net acid excretion in 141 healthy people on 20 different diets. The ratio of protein to potassium in the diet alone explained about 71 percent of the differences. For you, this means: it is less about cutting protein than about whether there are enough potassium-rich vegetables and fruit next to it.
DOI: 10.1093/ajcn/68.3.576From this a second value emerged, NEAP, the estimated daily net acid production. PRAL and NEAP are not blood values. They are calculated values for your kidneys' workload. And these are exactly the values research works with today.
In the French E3N-EPIC cohort, Guy Fagherazzi and colleagues followed 66,485 women over 14 years. Women with the highest dietary acid load had a 56 percent higher risk of developing type 2 diabetes than women with the lowest. This is an observation, not proof of cause and effect, because a low-acid diet is usually also richer in vegetables and less processed overall.
DOI: 10.1007/s00125-013-3100-0A World Health Organization group led by Nancy Aburto pooled the data on potassium intake in the BMJ in 2013. More potassium lowered systolic blood pressure in adults by about 3.5 mmHg on average, especially in people with high blood pressure, and in cohort studies it was associated with a 24 percent lower stroke risk. With healthy kidney function, there were no adverse effects on kidney function or blood lipids.
DOI: 10.1136/bmj.f1378In 2012, the Canadian family physician Gerry Schwalfenberg reviewed the literature on the alkaline diet, including popular books. His conclusion is cautious: an alkaline diet might have some value in chronic diseases, and further studies are needed. I find this restraint likeable. It matches pretty much exactly what can be said today.
Seen through the four KPNI lenses
When I look at this topic through the lens of clinical psychoneuroimmunology, I see less an acid battle and more a question of supply. The following points are partly well supported, partly mechanistic considerations, and I label them as such on purpose.
Metabolism
Observational data link a high acid load with more type 2 diabetes. Whether the acid load itself affects insulin sensitivity or merely reflects diet quality is debated and remains open.
Nervous system
Potassium and magnesium are involved in the electrical excitability of nerves and muscles. A diet rich in vegetables, nuts and legumes supplies both. That is basic physiology, not an alkaline effect.
Hormonal system
The kidneys are also a hormonal organ. In kidney patients, one study showed that fruit and vegetables can lower markers of the local angiotensin system. Whether this applies to healthy people has not been studied.
Immune system
Vegetables, fruit and legumes bring fiber and plant compounds that might influence inflammatory processes via the gut microbiome. Here, too, the possible benefit lies in diet quality, not in pH.
The alkaline cleanse wrapped a good idea in the wrong story. The idea: more plants, more potassium, fewer highly processed and very protein-heavy meals without vegetables. The wrong story: toxic deposits and acidic blood. You may keep the idea and hand back the story.
And now you know why I don't wave off the alkaline idea, but translate it.
Where it gets medically serious: the kidneys
Thesis: In chronic kidney disease, acid load is not a wellness question but a medical topic with solid studies.
This is where the story turns. When the kidneys weaken, at some point they can no longer fully manage the daily acid excretion. Bicarbonate in the blood drops. And at that point, acid-base balance is suddenly no longer a myth, but medicine.
Tanushree Banerjee and colleagues followed 1,486 adults with chronic kidney disease in a US population study for an average of 14 years. Those in the top third of acid load had about a threefold higher risk of needing dialysis than those in the bottom third. This too is an observation, but it fits with the intervention studies.
DOI: 10.1681/ASN.2014040332A London group led by Ione de Brito-Ashurst treated 134 people with advanced kidney disease and low bicarbonate for two years with either sodium bicarbonate or standard care. Kidney function declined considerably more slowly under bicarbonate, and only 6.5 instead of 33 percent required dialysis. For kidney patients, physician-guided alkali therapy is therefore a tool to be taken seriously.
DOI: 10.1681/ASN.2008111205Nimrit Goraya and Donald Wesson from Texas compared 108 people with stage 3 kidney disease over three years: standard care, sodium bicarbonate, or base-producing fruit and vegetables, each dosed to roughly halve the acid load. With bicarbonate and with fruit and vegetables, less kidney function was lost than under standard care. An earlier study by the same group in stage 4 found comparable kidney function after one year under fruit and vegetables as under bicarbonate, without a rise in blood potassium.
DOI: 10.1038/ki.2014.83These studies ran under close medical supervision. With reduced kidney function, heart failure or medications such as ACE inhibitors, sartans or potassium-sparing diuretics, additional potassium can be dangerous. Many alkaline powders contain potassium. Please no alkaline cleanse and no alkaline powder on your own; instead, have kidney values, potassium and bicarbonate checked by a physician.
The fascinating part: exactly where acid-base balance becomes medically relevant, ordinary fruit and vegetables perform in studies similarly to a medication. So the core of the alkaline idea is not esoteric. It just belongs in a different place than the one marketing puts it in.
And now you know why I talk about acid load with kidney patients and about vegetables with healthy people.
What an alkaline cleanse can do, and what it can't
Thesis: An alkaline cleanse can feel good. The reason most likely lies in what you leave out, not in de-acidifying.
Many people really do feel better during an alkaline week. I don't want to downplay that. Just look at everything that happens at the same time in such a week: no alcohol, hardly any sugar, no processed meat, no ready meals, plenty of vegetables, plenty of water, often more rest.
Each of these points can make a difference. Blood pH is not one of them, because it was already in the normal range before and it is afterwards too. The good news: you can keep the effective part without powders, test strips and cleanse packages. Not for one week, but as a basic pattern.
For me, this is also the real moment of freedom in this topic. When you no longer have to ask a strip every morning whether you are "too acidic," you win something back: trust in a body that regulates far more wisely than any cleanse could. Health then becomes not a daily exam, but a habit that carries you.
Three levers that remain from the alkaline idea
- Vegetables with every meal: Make vegetables, salad, herbs or fruit a fixed partner of every meal, ideally half the plate. That brings potassium, magnesium and fiber at the same time.
- Pair protein instead of cutting it: Protein stays important, especially for muscles and in older age. What matters is the ratio. Consistently combine meat, eggs, cheese or legumes with a large portion of vegetables.
- Measure what counts: Put the urine test strip away. If you have high blood pressure, diabetes or kidney risks, have creatinine, eGFR, potassium and, if needed, blood bicarbonate checked by a physician instead.
Where the science ends and my assessment begins
- Well supported: the tight regulation of blood pH by buffers, lungs and kidneys, the influence of diet on urine pH, the blood-pressure-lowering effect of potassium in high blood pressure, the benefit of alkali therapy in chronic kidney disease with low bicarbonate.
- Well studied, no evidence of benefit: alkaline diets to protect bone, alkaline diets and alkaline water for cancer prevention.
- Observational data, cause unclear: the association between high acid load and type 2 diabetes in healthy people.
- Open and not yet ready for recommendations: whether alkaline supplements can meaningfully affect bone density in healthy people.
- My observation, without a study basis: that the feeling of over-acidity often hides exhaustion that deserves a more thorough search.
If you want to dig deeper into how your body can be relieved without a cleanse, also read my texts on gentle everyday detox and on detox cleanses with juice and tea.
And now you know why you don't need an alkaline cleanse to live the healthy part of it.
Frequently asked questions about over-acidity and alkaline cleanses
Can your diet make you over-acidic?
Not your blood, as long as your lungs and kidneys are healthy. Blood pH is held tightly between 7.35 and 7.45. Buffers in the blood capture acids immediately, the lungs breathe out carbon dioxide, and the kidneys excrete acid and generate new bicarbonate. What your diet changes is the amount of acid your kidneys have to excrete each day, and with it the pH of your urine. True acidification of the blood is called acidosis and is a medical finding, not a dietary feeling.
What is metabolic acidosis?
Metabolic acidosis is present when bicarbonate in the blood drops and blood pH falls. Acute forms usually arise from an overproduction of acids, such as ketoacids in uncontrolled diabetes or lactic acid in shock and severe infections. That is an emergency. Chronic forms are often linked to reduced kidney function. Both are diagnosed with a blood gas analysis or blood tests, not with test strips and not from symptoms such as fatigue alone.
What does a urine pH test strip measure?
It measures the pH of your urine, not that of your blood or your tissues. Urine pH fluctuates over the day and depends strongly on what you have eaten. Work by Remer and Manz showed a close relationship between the kidneys' net acid excretion and urine pH. Acidic urine mainly means that your kidneys are excreting acid. That is their job and more a sign of working regulation than of a problem.
Are there toxic deposits an alkaline cleanse can flush out?
So-called acid deposits or slag are not a physiological concept. There are no acid deposits in connective tissue that an alkaline cleanse would need to dissolve. Acids from metabolism are continuously buffered, breathed out or excreted through the kidneys. What an alkaline cleanse does change is your diet: more vegetables, more fruit, less processed meat, cheese and highly processed foods. That part can be worthwhile for your health, just for reasons other than detoxing.
Does an acid-forming diet harm your bones?
The evidence does not support it. In a meta-analysis by Fenton and colleagues, higher acid excretion did increase calcium in the urine, but it did not change the body's calcium balance. A larger systematic review by the same group found no evidence of a causal link between acid load and osteoporosis. A more recent meta-analysis also saw no effect of acid-forming diets on bone density, though it found hints that alkaline supplements might raise bone density slightly. This remains an open field of research.
Can an alkaline diet or alkaline water prevent cancer?
There is no evidence for that. A systematic review by Fenton and Huang screened more than 8,000 citations and found only a single usable study, a cohort study on bladder cancer with no significant association. There were no randomized trials. The authors conclude that promoting alkaline diets and alkaline water for cancer prevention or cancer treatment is not justified. A tumor alters its own microenvironment, but your diet does not change the pH of your blood.
What do PRAL and NEAP mean?
PRAL stands for Potential Renal Acid Load, the potential acid load a food places on the kidneys. In Remer and Manz, hard cheese reaches up to about 24 milliequivalents per 100 grams, while fruit and vegetables average about minus 3. NEAP stands for Net Endogenous Acid Production, the estimated daily net acid production. Frassetto and colleagues were able to estimate it well from the ratio of protein to potassium in the diet. Both values describe the work of the kidneys, not blood pH.
Is dietary acid load linked to diabetes?
Observational studies suggest so. In the French E3N-EPIC cohort of 66,485 women, participants with the highest acid load had a 56 percent higher risk of type 2 diabetes over 14 years than those with the lowest. That does not prove cause. A low-acid diet is usually also richer in vegetables and fiber and less processed. How much is due to the acid load itself remains open.
Why does potassium matter for acid-base balance?
In fruit and vegetables, potassium mostly comes together with organic anions such as citrate, from which the body can form bicarbonate. That is why a potassium-rich diet lowers the acid load on the kidneys. Independently of this, potassium matters for blood pressure. A meta-analysis in the BMJ found that higher potassium intake was associated with systolic blood pressure about 3.5 mmHg lower, mainly in people with high blood pressure, and a 24 percent lower stroke risk in cohort studies. Caution applies in kidney disease, because potassium can build up there.
Do alkaline powders make sense in kidney disease?
In chronic kidney disease with low bicarbonate, alkali therapy is a recognized medical topic. In a randomized trial of 134 people, sodium bicarbonate slowed the decline of kidney function over two years. In further studies, fruit and vegetables performed similarly to bicarbonate. Especially here, though: no self-treatment. Many alkaline powders contain potassium, and with reduced kidney function or certain blood pressure medications, too much potassium can be dangerous. This belongs in a physician's hands.
What is left of the alkaline cleanse in the end?
A healthy core without the myth around it. You do not need to de-acidify your blood. But a diet rich in vegetables, fruit, legumes, nuts and herbs supplies potassium, magnesium and fiber and lowers the acid load on your kidneys along the way. That part may benefit blood pressure, metabolism and kidneys. You need neither test strips nor alkaline powder nor a cleanse with a start and end date for it.
Keep reading in the Detox Guide
All articles in the Detox Guide
- Liver detox: what can ease its load
- Liver phase 1 and phase 2 explained
- Glutathione, the master antioxidant
- Bitters: dandelion, artichoke and digestion
- Gut, elimination and detoxification
- Stimulating and supporting the lymphatic system
- Fasting, detoxification and autophagy
- Detox cleanses, juice cleanses and detox teas, critically examined
- Gentle everyday detox without a cleanse
Sources
- Hamm LL, Nakhoul N, Hering-Smith KS. Acid-Base Homeostasis. Clin J Am Soc Nephrol. 2015;10(12):2232-42. DOI: 10.2215/CJN.07400715 [Review, physiology]
- Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol. 2010;6(5):274-85. DOI: 10.1038/nrneph.2010.33 [Review, pathophysiology]
- Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc. 1995;95(7):791-7. DOI: 10.1016/S0002-8223(95)00219-7 [Pathophysiology, calculation model]
- Frassetto LA, Todd KM, Morris RC, Sebastian A. Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am J Clin Nutr. 1998;68(3):576-83. DOI: 10.1093/ajcn/68.3.576 [Pathophysiology, human study, n=141]
- Fenton TR, Lyon AW, Eliasziw M, Tough SC, Hanley DA. Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res. 2009;24(11):1835-40. DOI: 10.1359/jbmr.090515 [Meta-analysis, k=5]
- Fenton TR, Tough SC, Lyon AW, Eliasziw M, Hanley DA. Causal assessment of dietary acid load and bone disease: a systematic review & meta-analysis applying Hill's epidemiologic criteria for causality. Nutr J. 2011;10:41. DOI: 10.1186/1475-2891-10-41 [Meta-analysis, systematic review, 55 studies]
- Han Y, An M, Yang L, Li L, Rao S, Cheng Y. Effect of Acid or Base Interventions on Bone Health: A Systematic Review, Meta-Analysis, and Meta-Regression. Adv Nutr. 2021;12(4):1540-1557. DOI: 10.1093/advances/nmab002 [Meta-analysis, 26 RCTs]
- Fenton TR, Huang T. Systematic review of the association between dietary acid load, alkaline water and cancer. BMJ Open. 2016;6(6):e010438. DOI: 10.1136/bmjopen-2015-010438 [Systematic review]
- Schwalfenberg GK. The alkaline diet: is there evidence that an alkaline pH diet benefits health? J Environ Public Health. 2012;2012:727630. DOI: 10.1155/2012/727630 [Review]
- Fagherazzi G, Vilier A, Bonnet F, Lajous M, Balkau B, Boutron-Ruault MC, Clavel-Chapelon F. Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study. Diabetologia. 2014;57(2):313-20. DOI: 10.1007/s00125-013-3100-0 [Cohort study, n=66,485]
- Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ. 2013;346:f1378. DOI: 10.1136/bmj.f1378 [Meta-analysis, 22 RCTs, 11 cohorts]
- Banerjee T, Crews DC, Wesson DE, Tilea AM, Saran R, Ríos-Burrows N, Williams DE, Powe NR. High Dietary Acid Load Predicts ESRD among Adults with CKD. J Am Soc Nephrol. 2015;26(7):1693-700. DOI: 10.1681/ASN.2014040332 [Cohort study, n=1,486]
- de Brito-Ashurst I, Varagunam M, Raftery MJ, Yaqoob MM. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol. 2009;20(9):2075-84. DOI: 10.1681/ASN.2008111205 [RCT, n=134]
- Goraya N, Simoni J, Jo CH, Wesson DE. Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate. Kidney Int. 2014;86(5):1031-8. DOI: 10.1038/ki.2014.83 [RCT, n=108]
- Goraya N, Simoni J, Jo CH, Wesson DE. A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate. Clin J Am Soc Nephrol. 2013;8(3):371-81. DOI: 10.2215/CJN.02430312 [RCT, n=71]
On the strength of the evidence: The regulation of blood pH and the role of the kidneys are very well established physiologically. The statements on bone and cancer are based on systematic reviews and meta-analyses. The links between acid load and diabetes or kidney failure come from observational studies and show associations, not established causes. The studies on alkali therapy were conducted in people with chronic kidney disease under medical supervision and cannot be transferred directly to healthy people. This text does not replace medical advice or a diagnosis.