Last month we talked about the nutrients that are important to consume for healthy bones. Remember the “stars of the show” calcium and vitamin D, but the “supporting cast” contains over 15 other nutrients also important in maintaining bone health.

Let’s talk this month about the importance of a properly balanced pH and it’s effect on bone health as well as other health benefits.

So, what is pH and why is it important to consider?

PH stands for the “potential of hydrogen” . The pH of fluid tells you how alkaline or acidic something is. PH is measured on a scale of 0-14, with 7 being considered pH neutral. The body is designed to operate within a very narrow pH zone. Optimally we should be a little on the alkaline side-with a blood pH of around 7.365-7.45. Keep in mind that this does not reflect the pH of all bodily fluids or tissues, just the blood. For example, in the stomach an acidic pH of 3 or less is required to maintain adequate digestion of nutrients and to protect against microbial infections. The pH of the skin (4-6.5) is also acidic to act as a protectant barrier to microbial overgrowth.

The blood or serum is what bathes all the other cells within our bodies. This pH range then, in the blood, is very important to the overall health of the cells within the body. A minor fluctuation of in the blood’s pH can result in imbalances and create stressors on the body leading to disease states. Inflammation, arthritis, heartburn, poor circulation, skin conditions, eczema, fatigue, irritable bowel syndrome, and a weakened immune system may all be related to alterations in the body’s ability to maintain an optimal pH.

When it comes to pH and net acid load on the diet, there has been considerable change from when we humans lived as hunter gatherers. With the agricultural revolution and then with the industrialization of foods there has been a significant shift in the mineral content of our food. It is now widely known that there has been a decrease in potassium (K) compared to sodium (Na) and an increase in Chloride (Cl) compared to bicarbonate. As well, diets today are much poorer in magnesium and fiber and very high in saturated fats, sugars, sodium, and chloride. These triggers-an altered intake of known buffers to acidity, a diet rich in fats, sugars, processed carbohydrates and alcohol may induce a relative metabolic acidosis. When the pH is not optimal, more free radicals are created. Free radicals are negatively charged ions and can act as tissue damagers…If they are not properly neutralized or “detoxified” by the body. This is how disease is created.

For most of us, as we age and continue to eat a modern diet, there is some gradual loss of renal acid/base regulatory function and a resultant additional strain on the body to maintain proper pH. Recall that the body is incredibly efficient at maintaining the critical narrow range of Ph in the blood. For this reason, with the exception of severe, critical disease, the serum or blood pH is normal, but the urine or saliva pH variable may reflect this strain.

The urine may have a variable pH from acid to alkaline depending on the body’s need for balancing the internal environment. Food can be categorized by their potential acid load (PRAL). Foods that have a high acid load in general are: meats, dairy, fried foods, and processed grains. Foods that are alkali rich are fruits and vegetables. Not hard to remember!!!

So, now that we understand the basics regarding pH and that the Standard American Diet (SAD) sets us up for a more acid environment, Let’s get back to bone health.

Calcium represents a large reservoir of base in our body. In response to an acid load, as in the modern diet, calcium salts are released into the systemic circulation to bring about homeostasis-in other words, maintain a proper pH. One study estimated that the amount of calcium lost in the urine over a lifetime could be over half the skeletal mass of calcium. Keep in mind that calcium and the balance of other minerals in the blood is not just attributed to our acid base status. THis is a very complex system with many regulatory factors. For instance, bone minerals that are wasted in the urine may be compensated for by increased intestinal absorption of calcium, magnesium and phosphate. This is directly a result of vitamin D. More than 50% of the population is deficient in Vitamin D. So, combine a diet rich in acid forming foods, food already deficient in minerals, and low Vitamin D status and we have the perfect environment to promote osteoporosis.

I could not find any study to date that directly compared an acid rich diet with an alkaline diet and its direct effect on the development of osteoporosis, but if we understand the stress it creates on the body, then we certainly would want to reduce the intake of acid rich foods on a chronic basis.

In the standard American diet the typical ratio of acidic to alkaline foods is 80/20. Ideally this ratio should be flipped. More like 60-80 % alkaline and 20-40 % from acidic.

So, how does one measure pH? One of the easiest ways to measure pH is in a first morning void of urine, before you eat or drink anything. You can obtain urine strips from the pharmacy. I recommend if you are going to do this, sample your urine three to four times in a week for a two to three week period and then take the average. A urine pH should be ideally above 6.5. If your urine pH is consistently below this marker, talk to your doctor about this. You may want to begin here in making changes in your diet. Remember, the standard American Diet (SAD) is high in processed grains, saturated fats, low in vegetables, fruits and fibers-all the things that we now know can put stain on the acid buffering system in our body. Remember FOOD is MEDICINE, make changes to your diet today to promote the intake of more vegetables, fruits and healthy grains to improve overall health!!! Not only will you protect your body from further stress, but youe will feel better as well, I guarantee it!!

Beware about scanning the internet for foods that are rich in alkaline forming and foods to avoid because they are acidic. This will cause you extreme confusion. Some foods, take for example a lemon, that are thought be very acidic, acutally create a more alakaline load in the body. My take home point?? Get rid of the junk-throw away all the excesses-coffee, alcohol, fatty meats, processed grains, fried foods, processed cheeses, and eat more fresh vegetable and fruit everyday. If you have trouble altering your pH with these suggestions, see your docor for a more complete list of foods and suggestions.

A study posted this month in JAMA-the Journal of the American Medical Association-reported that a low glycemic load diet may be just what is needed to improve the metabolic syndrome. What is the metabolic syndrome? Last month I wrote about the set of biomarkers that define the syndrome. Recall these biomarkers may be warning signs, or red flags, for the development of diabetes and cardiovascular disease. This means an increase of stroke, high blood pressure and heart attacks and maybe even alzheimers disease, arthritis, and osteoporosis. There is accumulating evidence that the majority of chronic disease today can be prevented by reducing the incidence of metabolic syndrome.

People frequently ask me “what diet type is best?” when trying to reduce body fat and control factors leading to the metabolic sndrome. So far that answer has yet to be determined. This hallmark study, however, gives some incite into that answer. This is a summary of the article taken directly from Internal Medicine News July issue:

“Three different diets designed to maintain a recent weight loss were found to exert markedly different metabolic effects independently of their energy content in obese and overweight young adults, according to a report in the June 27 issue of JAMA.

“The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective,” said Cara B. Ebbeling, Ph.D., of the New Balance Foundation Obesity Prevention Center, Children’s Hospital Boston, and her associates.

Researchers took a close look at the effects of three weight-loss maintenance diets on energy, hormones and components of the metabolic syndrome. Each had markedly different metabolic effects.

The researchers performed a controlled feeding study to compare the effects of three weight-loss-maintenance diets on energy expenditure, hormones, and components of the metabolic syndrome. Their first step was to screen 681 men and women aged 18-40 years with a BMI of 27 or higher for participation in the study. Of these, only 32 potential subjects (17 men and 15 women) met entry criteria and agreed to the rigorous dietary restrictions of the study. Of these 32 subjects, 21 completed the study and were included in the data analysis.

During the run-in phase of the study, subjects followed a standard low-calorie diet that restricted energy intake to achieve a 12.5% decrease in body weight. Detailed assessments also were done to establish each subject’s energy requirements for stabilizing their weight at this reduced level.

After the subjects achieved a 10%-15% weight reduction, they each consumed one of the three isocaloric diets for 4 weeks, then switched to another of the diets for another 4 weeks, then to the third diet for a final 4 weeks in a three-way crossover design.

The three diets were the following: a low-fat diet with a high glycemic load and 20% of energy from protein, which reflected conventional recommendations to reduce fat, increase whole grain products, and include a variety of vegetables and fruits; a low-glycemic-index diet with moderate glycemic load and 20% of energy from protein, which replaced some grain products and starchy vegetables with other vegetables, legumes, and fruits; and a very-low-carbohydrate diet with a low glycemic load and 30% of energy from protein, which was modeled on the Atkins diet.

Body weight did not differ significantly among the three maintenance diets, nor did total physical activity or time spent performing moderate to vigorous-intensity activity. Subjects’ ratings of subjective hunger and well-being did not differ significantly among the diets, and blood pressure levels also did not differ.

Both resting energy expenditure and total energy expenditure decreased with all the diets, but the decrease was significantly greater with the low-fat diet. In addition, serum leptin levels were highest with the low-fat diet. These two findings suggest that people following the low-fat diet would be more likely to regain weight than those following the other diets, Dr. Ebbeling and her colleagues said (JAMA 2012;307:2627-34).

Moreover, the low-fat diet also had the most unfavorable effects on peripheral and hepatic insulin sensitivity, serum HDL cholesterol, triglycerides, and plasminogen activator inhibitor 1.

In contrast, the very-low-carbohydrate diet had the most favorable effects on these components of the metabolic syndrome and on energy expenditure.

The very-low-carbohydrate diet, however, produced higher C-reactive protein levels and higher cortisol excretion levels than the other diets, both of which signal physiological stress and chronic inflammation. In addition, “higher cortisol levels may promote adiposity, insulin resistance, and cardiovascular disease,” the investigators wrote.”

After reading this I felt very confident in the lifestyle program we are offering at Balanced Well-Being Healthcare. Our program combines a balanced portion of carbs, fats and protein while maintaining a low glycemic or sugar load. I know that much more research is needed in determining this question “what diet is right for me?” For now, I feel strongly that reducing carbs , while reducing glycemic, or sugar load and allowing for healthy fats is the right balance. At Balanced Well-Being Healthcare we carefully and cautiously follow all biomarkers of metabolic syndrome and look for signs and/or symptoms of inflammation or high cortisol when recommending any lifestyle changes.

Call us today to learn about our lifestyle management program!

I am so excited to finally be working in an arena where I can make a difference in peoples longterm health. Today, in America, we are doing little to nothing to prevent chronic disease. We are surrounded by more and more people we know developing cancer, diabetes, obesity, hypertension, osteoporosis, arthritis, thyroid disease and the list goes on!! I know with aggressive screening and patient education that we can start to prevent chronic disease-but it takes a commitment!! We need patients who are motivated and interested. We need doctors who are educated and knowledgeable about prevention and treatment.

My practice has been open for just short of 6 weeks. In this short time I have aready diagnosed ten people with metabolic syndrome and insulin resistance. This syndrome and health problem can cause chronic disease if untreated. It can often easliy be reversed with lifestyle modification and proper nutrition.

What is Metabolic Syndrome?

Metabolic syndrome is not a complex of symptoms or a disease. It is a set of biomarkers that define an increase of developing cardiovascular disease, diabetes, stroke risk and even arthritis and alzheimers disease.

The are FIVE main biomarkers:

1.Waist circumference >40 inches for men, >35 inches for women

2.Elevated Blood Pressure. A systolic pressure >130; diastolic >85

3.Elevated TGA’s >150

4. A low HDL cholesterol < 40 for men and <50 for women

5.A fasting blood glucose >100.

HAve you had all these biomarkers checked?

These guidelines are put forth by the National Cholesterol Education Program. My own opinion is that even this is not a good enough screening tool!!

At Balanced Well Being Healthcare we aggressively screen for cardiometabolic disease and early warning signs. For instance, in the 10 patients I mentioned that we have diagnosed this month alone-all of them had normal fasting glucose. However, when we asked them to perform a glucose challenge test and measured insulin levels fasting and post 2 hour glucose challenge-all of them were abnormal. What that means is when insulin levels are going up, the body is becoming resistant to insulin. The pancreas has to put out more and more insulin in order to meet demands because insulin becomes ineffective at doing its job. This abnormal insulin level is the first warning that things are headed in the wrong direction. In addition, we test body composition. Even people who have a normal waist circumference, they may hide fat around their middle and surrounding their abdominal organs. Body composition testing can pick up this fat. We call this visceral fat. Visceral fat can be very dangerous. It acts like a hormonal organ and secretes inflammatory mediators in the body. These mediators lead to insulin resistance and if untreated this can become full blown diabetes. I addition, it usually results in hypertension, chronic aches and pains, elevated levels of cholesterol and of course increase likelihood of chronic disease.

If you already have high blood pressure, high cholesterol, carry excess weight around your middle, have a strong family history of cardiovascular, or want to prevent chronic disease you need to be screened. I recommend at the minimum body composition testing, fasting glucose and insulin levels, a glucose challenge test with 2 hour insulin and glucose levels, markers of inflammation in the body and a more detailed examination of your cholesterol profile.

Take control of your healthcare and get the proper testing. If your doctor has not measured your waist or hips or talked about your Body Mass Index (BMI)-he probably isn’t thinking about your longterm healthcare risks. Demand better care and prevention today!!!