Better Bones Foundation
Research and publications on acid-alkaline balance
By Dr. Susan E. Brown, PhD
The relationship between bone and systemic acid-base balance is considered by Dr. Susan Brown and the Better Bones Foundation to be one of critical importance. Indeed, it is our opinion that chronic low-grade metabolic acidosis can be seen as the major hidden cause of osteoporosis. To that end, we explore in full the relationship between bone and systemic pH (acid-base balance) in our book, Better Bones, Better Body and in our article Acid-alkaline balance and its effect on bone health. Additionally, one of the primary goals of the Better Bones Foundation is to conduct original research on pH balance and bone. Our first piece of research focused on the value of first-morning urine pH measurements, and the second on interstitial cystitis and pH balance. Below we discuss in more detail our research on this topic to date.
First morning urine pH measurement
One of the Better Bones Foundation’s primary projects on acid-alkaline balance involved collaborative research with Dr. Susan Whiting, of the University of Saskatchewan, on the relationship between first morning urine pH measurement and net acid load. The abstract of these findings on the value of first morning urine pH measurement, as presented at the 2002 ASBMR (American Society for Bone and Mineral Research) meeting by investigators Susan Whiting, PhD, Janet Bell, and Susan E. Brown, PhD, CCN, is provided below.
First morning urine measured with pH paper strips reflects acid excretion
Susan J. Whiting and Janet Bell, College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Saskatoon, SK, S7N 5C9; and Susan E. Brown, Better Bones Foundation, 605 Franklin Park Drive, East Syracuse, NY 13057.
Net acid excretion (NAE) is implicated in bone loss, as increased calcium loss is seen with a high net acid excretion. Dietary protein is identified as a significant producer of acid, whereas fruits and vegetables may counteract this effect through the production of metabolizable organic anions which buffer acid. Determination of NAE is important in recognizing the effect diet may have on bone. Most commonly, a 24-hour urine collection is obtained for measurement of NAE, where NAE is measured as titratable acidity minus bicarbonate (TA – bicarb) plus ammonium NH4+. However, this measurement can be inconvenient, and pH measured on first morning urine with semi-quantitative paper strips may be a practical estimator of NAE. We recruited 23 (4M, 19F) healthy subjects ages 20–50 y, who recorded dietary intake for a day during which they collected urine from approximately 7 am to 11 pm in one container (“day”), and approximately 11 pm to 7 am (“overnight,” ON) in a separate container. The first morning void contained ON urine. Subjects also provided a 2-hour fasting urine at 9 am. Paper pH strips (colorpHast ®, EM-Reagents, range 4–7) were used to measure pH of the ON urine, as would be done in practice. A second set of strips (pH range 6.5–10) was used if initial pH read high. Although measurement with pH paper strips was not significantly correlated with 24-hr NAE, there was a significant correlation with 24-hour TA – bicarb (r = –0.466, p<0.025). Further, pH strip measures were significantly correlated with ON NAE (r = -0.710, p<0.005). We noted that ON NAE was correlated with total NAE (r = 0.504, p<0.014). We conclude there is useful information is measuring first morning urine pH (which provides pH of urine formed overnight) to obtain an estimate of acid excretion. Paper pH strips appear to be useful in the absence of longer (more invasive) urine collections.
Dr. Susan Brown and the nonprofit Better Bones Foundation continue to actively solicit collaboration and exchange with other like-minded individuals and organizations concerned with the practical health implications of chronic low-grade metabolic acidosis. If you are interested in helping the Better Bones Foundation through funding, or have ideas on how we might fund any of our current research, please visit our section on how to support the Better Bones Foundation.
At the Better Bones Foundation we promote an all-natural approach to bone health based on the latest research and through consultation, education and outreach.
If you would like to help us further the work of the Better Bones Foundation, click here to make a donation. We are also happy to answer questions about Dr. Brown’s pioneering work in the field of bone health. Please call The Center for Better Bones today toll-free at 1-888-206-7119 to learn more.
Original Publication Date: 07/30/2004
Last Modified: 07/11/2014
Principal Author: Dr. Susan E. Brown, PhD