The alkaline diet, the acid-ash hypothesis and bone health

Tanis R. Fenton, PhD, RD

Dietitian/Epidemiologist, Adjunct Assistant Professor, Department of Community Health Sciences, University of Calgary

Numerous webpages, books for lay persons, and alternative health practitioners espouse that diets favouring protein foods (especially meat and dairy products) and grains produce excess acid, such as phosphate, that must be buffered. They claim that this buffering mobilizes bone mineral and increases urinary calcium excretion and loss of bone mass which can lead to osteoporosis. But the scientific evidence indicates otherwise.

Highlights

Promotion of the alkaline diet to prevent osteoporosis is not justified.
Calcium balance studies have not shown that increasing the diet acid load promotes skeletal bone mineral loss or osteoporosis.

Higher phosphate intakes are associated with increased calcium balance.
Protein appears to be beneficial to bone health

Popularly known as the “alkaline diet,” the acid-ash hypothesis has had only limited critical review. The hypothesis assumes that excess urinary calcium is equal to the loss of calcium from the skeleton. But urinary calcium excretion is only a surrogate measure because differences in calcium absorption can offset the calcium excretion.

Calcium balance is a superior means of measuring calcium status compared to urine calcium because it assesses effects of an intervention on the whole-body retention of calcium, and also takes into consideration alterations of calcium absorption.