PRAL: Understanding Potential Renal Acid Load for Kidney Disease
The Alkaline Diet — Better Bones August 17, Team Modern Western diets, with higher amounts of grains, meat and dairy, compared to fruits and vegetables, have a greater content of acid precursors vs. To prevent the accumulation of acid in the body and progressively increasing degrees of metabolic acidosis, the body has multiple systems to buffer and adjust the balance of acid, including bone which contains large quantities of alkaline salts of calcium.
But what does this mean for us women? If we decide to eat a mostly acidic diet, our clever bodies will draw calcium from our bones to reduce the acidic load on the body. This ultimately results in a depletion of bone mass! Do the foods you eat form an acid load or base relief in your body?
The PRAL food table can help serve as a guide. The PRAL food table provides information about the acid load of the foods you eat. All fish, meat, nuts, grains, dairy and legumes, once broken down in the body create an acidic load.
Turn the page and you will find the long list of alkaline foods which includes all your beautiful fruits and vegetables. So now you want to balance that acidic load by filling the rest of your plate with beautiful alkaline foods. This g has a PRAL load of Just eating broccoli alone with your gorgeous piece of salmon would mean you would need to eat almost 2kgs to balance the acid-alkaline balance of your plate!
No one loves broccoli that much. But if you take a closer look at the table, g of spinach provides a PRAL of Carrots — 4. Ultimately, you never want to have to count anything on your plate and that includes calories but you can start to see the quantity of vegetables and fruits one needs to be eating at each meal to ensure a good balance and ultimately stronger bones.
The easiest way? Aim to fill half to two thirds of your plate with different vegetables and some fruit at every meal and you will be pretty close. Maybe even do one or two vegetarian days a week! On those days where you struggle to get enough vegetables and fruits on your plate, try this alkalising juice.
Download your PRAL food chart here. The information refers to g of food. Search here!
How to calculate the Potential Renal Acid Load (PRAL) for the food you eat
Proponents of this diet claim that high acidity causes our bodies to steal minerals from our bones and organs.
High PRAL foods are to be avoided. Meat, fish, eggs, dairy, alcohol, wheat and yeast are the biggest offenders. Low PRAL foods are to be consumed daily—leafy greens, sea vegetables, some fruits, most vegetables and sprouted seeds. Neutral PRAL foods fruits, nuts, some grains and legumes are to be used occasionally in the diet see Supplement 1. These concepts are not new; H. Sherman created the first list of acidic and basic foods in when scientists began to investigate the functional properties of food8.
Popularity of this diet has grown in recent years. As with most fad diets, there are numerous blogs devoted to the alkaline eating pattern.
Some alkaline diet gurus, such as the Alkaline Sisters Julie and Yvonne, describe their results as dramatic weight reduction, relief from chronic back pain and total body healing2.
Others claim the diet protects from sarcopenia, improves immune function, prevents cancer, increases vitamin absorption and combats mineral deficiency1. Chiropractic and clinical nutrition celebrity Dr. Josh Axe claims that chronic disease will not occur in bodies with balanced pH levels. In most cases, our renal and respiratory systems are proficient at maintaining healthy pH levels.
If phosphate levels rise in the blood, bone resorption occurs. Osteoclasts break down bone and release calcium, which acts as a buffer to neutralize the phosphate. Alkaline diet followers maintain that this breakdown process depletes our bones of minerals and leads to osteoporosis.
However, current medical research shows that this is not the case. In a meta-analysis of the alkaline diet, researchers concluded that the pH of urine was not related to an increase in bone damage or fractures4.
The alkaline diet also maintains that phosphate intake causes calcium excretion and subsequently osteoporosis. However, in all studies reviewed, phosphate intake was found to increase levels of bone calcium and increase acid excretion4.
There is no evidence that higher phosphate intakes are detrimental to bone health. Axe claims that calcium in dairy products causes acidity and calcium loss, leading to osteoporosis1. Most practitioners in the medical and nutrition worlds know that dietary calcium has a protective effect against osteoporosis, and regular calcium intake is recommended for all individuals, especially children, adults and pregnant or nursing mothers5.
The body regulates calcium absorption and excretion to prevent our bones from deteriorating. When calcium levels are low, the parathyroid hormone increases calcium excretion from bones, while also increasing calcium resorption and absorption to rebuild the bone structure.
A healthy human body will regulate its own calcium levels, rather than steal from our bones as Dr. Axe suggests. Urinary calcium does not provide a good picture of calcium balance because this mineral is absorbed, secreted and lost in various ways throughout the body4. The biochemistry behind the alkaline diet is based on limited studies that consider urinary calcium excretion as proof that an acidic diet causes osteoporosis.
Practicality of the Alkaline Diet The alkaline diet may have minor benefits during anaerobic exercise. A study of 10 participants found that a low-acid diet increased anaerobic exercise performance, as compared to a high-acid diet3.
Participants who followed the low acid diet consumed 60 grams of protein per day, while the high-acid participants consumed grams per day3.
Current recommendations for endurance athletes are 1. The low-acid diet in this study would not provide enough protein to maintain athletic performance and muscle structure. It would not provide enough calcium, either; the Academy of Nutrition and Dietetics recommends mg of calcium per day for adults5.
The low-acid diet in this trial provided just mg per day. Even with this modified alkaline diet, the meal plans do not provide enough nutrients to maintain weight in any healthy adult, much less an athlete. It would be difficult to maintain micro and macronutrient requirements while adhering to an alkaline diet, and almost impossible if adhering to a strict alkaline diet and avoiding all animal-based proteins.
A strict alkaline diet is vegan by nature. Research indicates that vegan diets can cause nutrient deficiencies6. Recently, the German Nutrition Society published a position paper stating that a vegan diet is not suitable for children, adolescents, or pregnant or nursing women7.
Researchers cited vitamin B12 as the most notable deficiency but Omega-3, vitamin D, riboflavin, protein and mineral deficiencies are also commonly seen with vegan diets7. The alkaline diet recommends avoidance of meats, grains and dairy products, all of which contain bone-protecting protein, calcium and vitamin D. Strict alkaline diet followers are certainly at risk for developing nutrient deficiencies. Clinical Significance and Implications for Practice The principles of the alkaline diet are used clinically in two ways.
Sodium bicarbonate is used to correct blood imbalances and improve growth rates in children with metabolic acidosis, and the higher pH level that results from an alkaline diet can make some chemotherapeutic agents more effective4. For healthy individuals, however, an alkaline diet does not have the benefits that its followers proclaim.
Though some studies suggest that a low-acid diet can moderately increase exercise endurance, the diet is low in calories, protein and calcium, expensive, time-consuming and impractical to maintain. Furthermore, a strict alkaline diet poses serious risks of vitamin and mineral deficiencies.
The limited and inconsistent research that supports this diet is certainly not enough to warrant recommendation of its use. I would not recommend an alkaline diet, as it would be difficult to maintain any level of athletic performance and avoid deficiencies with a diet devoid of animal, egg and dairy-based proteins.
A minor increase in performance, based off the small cohort and very short duration found in one study does not transcend the risks this diet poses to long-term health. Supplement 1: Alkaline Food Chart.
Alkaline diet: the key to longevity and fighting chronic disease? Axe Web site. Accessed August 29, Alkaline sister: my story. Alkaline Sister Web site. Published Accessed September 1, Effects of dietary acid load on exercise metabolism and anaerobic exercise performance. Sports Sci and Med. Phosphate decreases urine calcium and increases calcium balance: a meta-analysis of the osteoporosis acid-ash diet hypothesis. Nutr Journ. Louis, MO: Elsevier; The impact of vegan diet on B status in healthy omnivores: a five-year prospective study.
Ernahrungs Umschau 63 04 : 92— Sherman H, Gettler A. The balance of acid-forming and base-forming elements in foods and its relation to ammonia metabolism. Columbia University; ;
19 Highly Alkaline Foods That Will Benefit Your Body
Beta-carotene can also help protect against cancer and help promote brighter, younger looking skin. If you need some carrot inspiration, The Healthy Foodie blog has a delicious recipe with step-by-step instructions for a shredded coleslaw-esque Carrot Salad right here. You can get the plan — for FREE! Just click the image below to get started. And although oranges are famous for their vitamin C content, kiwi contains nearly five times the amount of vitamin C than an orange.
Kiwi is also a great source of fiber for improved digestion, as well as potassium for muscle function. I feature kiwi as an ingredient in my Tropical Chia Pudding Parfait right here. This is because cauliflower contains a nutrient called IndoleCarbinol or I3C that helps the body regulate estrogen levels. We come into contact with estrogen on a daily basis through estrogenic foods such as soychemicals in our environment such as plastics and pharmaceuticals drugs such as oral contraceptives 9.
High levels of estrogen are harmful to the body and can lead to weight gain, digestive symptoms such as bloating, as well as reproductive cancers and infertility.
Studies also support that cherries can help relieve inflammation linked to joint pain and arthritis, and may even prevent cardiovascular disease Cherries blend well in smoothies, such as this blood-sugar-balancing Peanut Butter and Cherry Protein Shake. I recommend this recipe as a great post-workout shake because it contains both plant-based protein and alkalizing nutrients. Ideally, a post-workout shake should always include alkaline foods.
Pears are also high in the antioxidant vitamin C, which helps protect cells from carcinogens. But hazelnuts are an exception.
Hazelnuts are best known for their contribution to the infamous nut butter, Nutella.
What Is PRAL & How Does It Affect Kidneys?
This is because pineapple contains a digestive enzyme called bromelain. Bromelain is also said to be helpful for killing off intestinal parasites. For optimal benefit, it will behoove us to select foods that are best for achieving and maintaining physical and mental well-being.
As you know, we all need water, proteins, carbohydrates, fats, vitamins and minerals. We are advised to have a balanced diet that includes lean proteins, vegetables, fruits, complex carbohydrates and water. For example, the DASH diet is a balanced eating plan that is flexible for most people to adopt.
Generally, our body does an excellent job of maintaining a stable balance in the various physiological processes that take place in our body. This natural tendency is called homeostasis. This is what keeps the blood pH of healthy people within a tight range of 7. A pH value of 7 is neutral.
A pH value less than 7 is acidic; a pH value greater than 7 is alkaline or basic. Therefore, the blood pH of a healthy individual is somewhat alkaline.
After we eat something, our body processes the food and absorbs the nutrients that it needs. Our kidneys help to pass the liquid waste as urine. Click here for a list PRAL levels for commonly consumed foods.
The Alkaline Diet – Better Bones
Joyce M. Her areas of expertise are diabetes and chronic kidney disease. Vergili enjoys long walks along the Hudson River and taking ballroom dance lessons with her husband. Dietitians On Demand is a nationwide staffing and recruiting company for registered dietitians, specializing in short-term, temporary and permanent-hire positions in acute care, long term care and food service positions.
Check out our job openingsrequest your coverage, or visit our store today! Acid balance, dietary acid load, and bone effects: A controversial subject, Nutrients ;10,; doi Fruit and vegetable treatment of chronic kidney disease-related metabolic acidosis reduced cardiovascular risk better than sodium bicarbonate, American Journal of Nephrology ; Diet and major renal outcomes: A prospective cohort study.