Dr. Susan Brown, and the Osteoporosis Education
Project, considers the link between bone and systemic acid/base
balance to be of critical importance. In fact, it is our opinion
that chronic low-grade metabolic acidosis is the major "hidden"
cause of osteoporosis. In our book, Better Bones, Better Body
and in our article Acid-Alkaline
Balance and Its Effect on Bone Health we explore in full
the relationship between bone and systemic pH (acid/base balance).
One goal of the Osteoporosis Education Project
is to conduct original research on pH balance and bone. Below
we discuss our research on this topic to date. Our first piece
of research focuses on the value of first morning urine pH measurements,
and the second on interstitial cystitis and pH
balance.
First Morning Urine
The Osteoporosis Education Project has conduct
several research projects on acid alkaline balance. One project
was collaborative research with Dr. Susan Whiting of the University
of Saskatchewan on the relationship between first morning urine
pH measurement and net acid load. For an abstract of these research
findings as presented at the 2002 ASBMR meetings, see the First
Morning pH abstract below. Investigators Susan Whiting, Ph.D.,
Janet Bell, and Susan E. Brown, Ph.D., CCN.
First Morning Urine Measured With pH Paper Strips
Reflects Acid Excretion
Susan J. Whiting, Janet Bell, College of Pharmacy and Nutrition,
University of Saskatchewan, 110 Science Place, Saskatoon, SK,
S7N 5C9 and Susan E. Brown, Osteoporosis Education Project,
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 fruit and vegetable 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 age 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 two-hour fasting urine at 9 am. pH paper 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. pH paper strips appear
to be useful in the absence of longer (more invasive) urine
collections.
The Osteoporosis Education Project has compile other important
acid alkaline balance abstracts
from the 2002 ADBMR conference.
Interstitial Cystitis and pH Balance
Chronic low grade metabolic acidosis is known to aggravate
the kidney and bladder worsen all forms of cystitis. Conversely
reducing urinary acid load should bring a degree of symptom
relief. In the Winter of 2003, we analyzed data from a intervention
study using alkalizing salts in the treatment of pain and urgency
from interstitial cystitis. The study used Tamer® Products
to alkalize. The symptom relief was very impressive. For full
study results, please see Excessive
Acidity May Aggravate Urinary Disorders - A Case Study - A Novel
Therapy For Interstitial Cystitis.
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