Acid-Base Balance

The functioning of bodily cells, tissues, organs, or entire systems is always influenced by the quality of the acid-base balance of the internal environment. Once such a balance is disrupted (in absolute values or at the level of tendencies that guide it in one direction or the other), biochemical processes are first affected, then cell functions, and subsequently, there is a divergence from the balance of all processes occurring in the body. Various diseases always stem from disruptions in the acid-base balance, including cardiovascular diseases (atherosclerotic processes are always accompanied by acidity disorders), inflammation, kidney dysfunction, dyspepsia, and others. Since diet contributes significantly to these situations, it is important to orient oneself in this issue and know the options for rectification. For this reason, the influence of diet on the organism's acid-base balance is an integral part of the principles of the Zone of Optimal Functioning (the sixth in order), on which we base our education philosophy in the field of nutrition and health.

We can assess the acid-base balance on two levels:

1. From the perspective of biochemically assessable processes occurring at partial levels in living systems.

2. From the perspective of tendencies occurring within individual processes.
   This view and approach are mainly taken by so-called alternative directions, led by Traditional Chinese Medicine.

Each perspective has its advantages, but when trying to apply them to diet and health in a holistic way, it is also necessary to take them with a certain reserve. In this regard, the best approach is to respect both perspectives.

In practice, the term "acid-base balance" has become somewhat discredited. This situation is caused, on one hand, by the effort of manufacturers and sellers of dietary supplements to boost sales of their products by claiming that most of the population suffers from so-called "acidosis," and then widely disseminating this belief throughout the population. On the other hand, it is the effort of scientists to debunk these activities due to their lack of scientific basis. Caught in the middle of these "discussions" stands the layperson, who has considerable difficulty in orienting themselves in the situation at all. Once the significance of acid-base balance is correctly understood, not only can these situations be avoided, but above all, we have in our hands a tool that we can successfully use to influence our health (or all processes that contribute to health). Let's take a closer look at both perspectives:

The Acid-Base Balance from the Perspective of Biochemistry

Acid-base balance is defined as the balance of acids and bases within the organism, which is also dynamic (in constant motion). This means that the ratio between formation and excretion of acids and bases is assessed, where these partial ratios are the basis for maintaining balance (homeostasis). The source of acids in the body is predominantly metabolism, whereas, for bases, it is diet.

Disruption of acid-base balance can lead in two directions: If acids prevail in the system (= lowering pH), this situation leads to acidosis. In the case of a predominance of bases (increasing pH), there is a tendency toward alkalosis.
Because the organism naturally tends to produce a greater amount of acidic substances (they are a source of protons, which leads to lowering the environmental pH), from here comes the layman's belief that their body tends towards so-called acidity, which needs to be preventively addressed through various dietary modifications, including the use of dietary supplements.

Each system in the body has a pH balance at different levels and within different ranges (intervals) of values. Therefore, if we want to evaluate the acid-base balance, it should always be in the context of the functioning of a particular part of the body. For example, the normal pH of blood differs from the pH of urine. Blood is a very sensitive indicator of pH deviations - the physiological range of pH in arterial blood ranges from 7.36 to 7.44. Values above 7.44 are termed “alkalemia”, and below 7.36 as "acidemia". Excessive pH deviations are dangerous to health and subsequently life-threatening (they alter enzyme structure, membrane permeability, or electrolyte distribution). Values lower than 6.8 and higher than 7.8 are incompatible with life.

Several systems affect (control) the acid-base balance in the organism:

1. Systems in the organism are set up to control the tendency to produce a higher proportion of acids through the buffer system (including, for example, hemoglobin, plasma proteins, bicarbonate, organic and inorganic phosphate).
   Acids are neutralized and then excreted from the body. Generally speaking, buffers adjust pH fluctuations only up to their buffering capacity. Regarding the ability of the organism to maintain homeostasis at the acid-base balance level, buffers play the so-called first line of defense, where these "balancing" mechanisms occur. Significant changes in pH in the systems occur only when the buffering capacity of the organism is exhausted, and the body thus loses the ability to maintain balance. Buffers manage pH fluctuations during regular metabolism, i.e., short-term, and react immediately.

2. The second system is respiration.
   The respiratory system affects the carbon dioxide content. Significant divergence in blood gas exchange can lead to two extreme states due to respiration:
   
   - If there is an accumulation of carbon dioxide (e.g., at reduced alveolar ventilation), the pH in the extracellular tissue drops, leading to the formation of respiratory acidosis.
   
   - If, on the other hand, there is a decrease in carbon dioxide concentration in the blood, the pH rises and the balance shifts toward respiratory alkalosis (these situations are less common in practice, occurring, for example, at lower oxygen concentrations in high-altitude conditions).

The center of the respiratory system is located in the brainstem (medulla oblongata), which reacts to changes in acid-base balance fairly quickly (about in 1–3 minutes, thus slower than buffer systems).

3. The third system maintaining acid-base balance is the kidneys, which play a complex role in keeping balance. In terms of time demand, they can respond on the order of hours to days. The kidneys are a system capable of effectively removing metabolism-produced acids from the body, thereby maintaining balance. They prevent the occurrence of so-called metabolic acidosis or alkalosis. There are several causes for these extreme states:
   In acidosis, for example, there is a significant increase in metabolic activity (through diet, physical exertion), a rapid loss of alkaline substances (e.g., diarrhea), intense vomiting, or diabetes (a state of advanced ketosis).
   Much rarer alkalosis states may arise when using preparations such as diuretics or baking soda in an attempt to address stomach acidity.

4. The fourth system playing a vital role in acid-base balance is the liver.
   This key organ of energy metabolism enters the acid-base balance mainly through the way it metabolizes ammonia formed during digestion.

5. The fifth and final system influencing acid-base processes is the heart, which affects the balance through the oxidation of lactate and ketones.

In summary, there are four basic disturbances of the acid-base balance:

1. Respiratory acidosis – decrease in blood pH due to an increase in CO2 concentration,
2. Respiratory alkalosis – increase in blood pH due to a decrease in CO2 concentration,
3. Metabolic acidosis - decrease in blood pH due to a reduction in base excess ([HCO₃^-]),
4. Metabolic alkalosis - increase in blood pH due to an increase in base excess ([HCO₃^-]).

Usually, they are examined in laboratories by determining specific values for pH, [HCO₃^-], CO₂, or O₂, including substances that influence these values, i.e., the concentration of cations (Na⁺, K⁺, Ca²⁺, Mg²), the concentration of anions (Cl^-, lactate, albumin), and the concentration of metabolites (urea, creatinine, ketones).

Therefore, assessing the state of acid-base balance is a fairly complex and, for a layperson, a very challenging process. It is also important to realize that acidosis and alkalosis are two extreme metabolic states that should always be diagnosed by a physician based on the aforementioned complete biochemical examination (for example, claiming that someone is suffering from metabolic acidosis merely based on urine pH measurement, as is common practice among laypeople, is essentially quackery). And because the definition of acid-base balance in modern medicine is truly about extreme balance disturbances, their solutions are correspondingly extreme - respiratory disorders are corrected, for example, with artificial lung ventilation, and metabolic disorders by dialysis.

The Acid-Base Balance from the Perspective of Metabolically Tendential Processes

This approach stems from the effort to view the functioning of the organism from a holistic perspective. It is a viewpoint that has developed and evolved gradually in the context of the historical development of certain cultures. Under no circumstances does it deny the modern scientific effort for a professional approach based on metabolic analyses. However, the fact is that the holistic conception of the term "acid-base balance" has a somewhat different meaning from what modern medicine presents, which causes discord and division in attempts to build bridges between these two "worlds." Here, acid-base balance is perceived as a set of processes and functions occurring in the body that, in the area of acid-base balance, proceed either in an "acidic" or a "basic" direction. This means that:

1. It assesses tendencies and directions in which metabolism is moving at the acid-base level,

2. It attempts to "foresee," from which its preventive efforts to rectify something that cannot be determined from biochemical analyses stem (one of the fundamental differences between the scientific and holistic approach to nutrition is that the modern-scientific one focuses on symptom suppression, while the holistic one seeks prevention, or addresses the root cause. Until agreement is reached on the approach, these two worlds will never agree).

3. It incorporates segmental methods into the solution of disturbances in acid-base balance, which are part of a whole (allegorically expressed as "many patches for one hole"). Because it is a tendency to evaluate the functioning of the body comprehensively, a number of factors contributing to acid-base balance are fairly respected. It deals with dietary adjustment, the system of breathing, sleep regime, stress, phytotherapy, movement, specific types of massage, etc.

Acid-base balance is most commonly related to diet, with the following factors being assessed:

1. Volume of diet.
The basic difference here is between moderation and gluttony, where both approaches fundamentally affect the quality of metabolic processes and their impact on acid-base balance.

2. The amount of macronutrients in the diet.
For example, an excess of simple sugars or proteins tends to lead to acid-forming reactions. Or high-fat diets (with a dominance of fats and minimal carbohydrates), based on the formation of ketosis, shift the acid-base balance in an acid-producing direction.

3. The amount and ratios of elements (minerals).
There are alkaline ( base-forming) minerals (sodium, potassium, calcium, magnesium, iron) and acid-forming elements (sulfur, phosphorus, chlorine, iodine). Based on their content in the diet, we can influence the acid-base processes occurring in the body. Generally, every food contains both types of minerals, and the ratios between them are decisive.

4. Method of food consumption.
Thorough chewing and the calm at mealtime are main factors influencing the quality of the entire digestion process and ensuing acid-base processes.

5. The method of food preparation.
For example, excessive temperature used in food preparation changes the nutrient structure (formation of trans fatty acids in fats, acrylamide from starches, etc.), and consumption of such foods affects even acid-base processes in the organism.

6. Evaluation of the type of food according to its influence on acid-base balance.
There are two types of acidic and basic foods:
A food can be either acidic itself (with a specific pH value) or acid-forming (after digestion, inducing an acidic reaction).
The same applies to bases - there are basic or base-forming foods.
For example, lemon contains strong acids (its pH is 2–3), but acts as a base-forming element in the organism. This is because, like many other kinds of fruits and vegetables, it contains many base-forming elements besides acids, which have the ability to lead the acid-base processes in such food digestion towards a base-producing direction (these elements are part of reactions that neutralize acids in the organism).

From the evaluation of these factors, it is possible not only to deduce how an individual's metabolism is set at the acid-base balance level, but also to adjust the dietary regime to set homeostasis. It should always be done with the understanding that these are general and unscientific indicators (which is not a "system error," but a fact that is an integral part of the holistic approach philosophy based on observation and individualized evaluation).