Over the years, I’ve had patients ask me if there’s any truths to claims that an “alkaline diet” could help prevent or treat cancer. Hype, scam or science? Lately, I’ve also seen alkaline water being sold on store shelves. Sound investment or marketing money grab? Here’s what the literature says about alkaline foods. Should you opt out of chemo and turn to alkaline water instead?
First of all, our body does a pretty awesome job at maintaining a stable pH. The term pH is a measure of how acidic or basic the water in our blood is and our body has many different mechanisms to keep pH in a very narrow range, from 7.35-7.45, with an average of 7.40. Unless affected by severe pathological conditions, our blood pH will stay in that normal range and barely ever budge.
Our body has many different mechanisms to maintain a stable pH. Firstly, we breathe out carbon dioxide, which in water, forms carbonic acid. So you could say that breathing attempts to “alkalize” your body. Just holding your breath will cause you to retain carbon dioxide and make your body more acidic. Other protective mechanisms also come into play. Our kidneys can secrete and eliminate H+, or hydrogen ions, which are acidic, and that lowers pH in the urine, and increases it in our blood. They can also recycle bicarbonate (HCO3-) back into our bloodstream, which is a base, and in turn also lowers acidity.
Unless you're suffering from complex medical conditions (diabetic ketoacidosis, renal failure, etc.) leading to excess acids or bases, your pH will remain perfectly normal.
Can diet have an effect on pH? Studies do show that acidic diets, aka those high in animal protein, refined foods, high in salt and low in fruits and vegetables can lead to subclinical metabolic acidosis, meaning that our pH will remain normal, but in the lower normal range. Even if “normal”, this lower-normal pH does require us to engage our protective defense mechanisms listed previously. What’s the actual real-life clinical implication? Does it actually change anything in terms of disease risk? Although “stressing“ our kidney defenses over the long term doesn’t sound advantageous, does it lead to any measurable negative clinical outcome?
Western diets do contribute to an increased acid load that could generate various degrees of subclinical metabolic acidosis, meaning that even though our blood pH remains normal, it does so at the expense of our kidneys that must recycle bicarbonate (seen by measurements of HCO3- of less than 24 mEq/L). Stronger forms of dietary induced metabolic acidosis have been found to contribute to the progression of chronic kidney disease and it’s for this reason that some have hypothesized that a more alkaline diet could maybe assist in preventing the progression of the kidney deterioration that is seen with age, or with other contributing diseases, like hypertension or diabetes.
Some studies have suggested that a diet with a lower acid load would improve subclinical metabolic acidosis (as defined by a low-normal pH with bicarbonate levels of less than 24 mEq/L), and that could potentially slow age related bone and muscle loss and slow the decline of kidney function (as measured by glomerular filtration rate).
Dietary acid load is greatly decreased by eating a diet low in processed foods, low in animal products, and high in fruits, vegetables, legumes and whole grains. A recent randomized controlled trial done by Dr. Neal Barnard and colleagues measured acid load of different diets in 240 patients (they measured PRAL, potential renal acid load and NEAP, net endogenous acid production) and confirmed that the acid load of a vegan diet was significantly lower than that of their control group. Decreased dietary acid load has been associated with improvements in body weight and insulin sensitivity, independent of energy intake.
Now that we know that plant-based diets are alkaline compared to standard and processed diets, what does that mean in terms of clinical significance? What should we think about people capitalizing by selling expensive alkaline water? How about the claims that an alkaline diet could cure cancer?
Most trends pick up steam quickly by having a grain of truth in their foundation. For example, studies have shown that tumor acidification, which can happen with rapid tumor growth associated with low oxygen concentrations, could be associated with tumor metastasis and spread. In regards to these findings, some have suggested that alkalizing treatments could be possible treatment avenues in the future. This is very far from proof that lower acidity in our diet alone would affect tumor or cancer survival. Although some studies have suggested that dietary acid load could influence tumor progression or carcinogenesis, these have not been proved or reproduced in clinical studies. Although we have meta-analysis showing that vegan’s have a 15% lower cancer rate than meat eaters, it’s impossible to attribute that solely to dietary acid load.
My conclusion? There’s pretty much no research to support or disprove the association between dietary acid load and cancer survival. Therefore, it’s absolutely unjustified to suggest people eat an alkaline diet, or purchase alkaline water solely for the purpose of preventing or surviving cancer. There’s a huge difference between correlation and causation, and although whole food plant-based diets are more alkaline and are associated with lower cancer rates than the processed diets that most Canadians eat, it’s impossible and irresponsible to think or imply that these findings are related solely to dietary acid load. The moral of the story is this: recommending a whole food plant-based for prevention and treatment of many chronic conditions is supported by scientific research, but recommending foods or products, including alkaline water in hopes of curing cancer or any other medical condition based purely on their alkalizing properties is not evidence based and is irresponsible. Companies will take grains of truth, disproportionately inflate them and then capitalize by selling their products to naïve and desperate people looking for a silver bullet.
If you’re looking to alkalize your body, no need to purchase expensive miracle drugs or gimmicks, just eat the way Mother Nature intended, and consume fruits, veggies, legumes, whole grains, nuts and seeds, all while minimizing animal products and processed junk. If you’re eating processed foods and animal products, and then washing it down with alkaline water, I’m afraid you just fell for a well thought out marketing trap.
Check out my website plantbaseddrjules.com and look for the “How To” section in the menu. There, you’ll find tips and tricks that helped me on my journey towards a plant-predominant diet. Everything there is completely free, no catches!
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Thanks so much for reading!
Plant-Based Dr. Jules 💚🌱
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Plant-based Dr Jules 🌱💚
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Osuna-Padilla IA, Leal-Escobar G, Garza-García CA, Rodríguez-Castellanos FE. Dietary Acid Load: mechanisms and evidence of its health repercussions. Nefrologia (Engl Ed). 2019 Jul-Aug;39(4):343-354. English, Spanish. doi: 10.1016/j.nefro.2018.10.005. Epub 2019 Feb 5. PMID: 30737117.
Applegate C, Mueller M, Zuniga KE. Influence of Dietary Acid Load on Exercise Performance. Int J Sport Nutr Exerc Metab. 2017 Jun;27(3):213-219. doi: 10.1123/ijsnem.2016-0186. Epub 2017 Jan 4. PMID: 28050921.
Ostrowska J, Janiszewska J, Szostak-Węgierek D. Dietary Acid Load and Cardiometabolic Risk Factors-A Narrative Review. Nutrients. 2020 Nov 7;12(11):3419. doi: 10.3390/nu12113419. PMID: 33171835; PMCID: PMC7695144.