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Nutrition Society Medal Lecture: The role of the skeleton in acid—base homeostasis

  • Susan A. New (a1)
Abstract

Nutritional strategies for optimising bone health throughout the life cycle are extremely important, since a dietary approach is more popular amongst osteoporosis sufferers than drug intervention, and long-term drug treatment compliance is relatively poor. As an exogenous factor, nutrition is amenable to change and has relevant public health implications. With the growing increase in life expectancy, hip fractures are predicted to rise dramatically in the next decade, and hence there is an urgent need for the implementation of public health strategies to target prevention of poor skeletal health on a population-wide basis. The role that the skeleton plays in acid-base homeostasis has been gaining increasing prominence in the literature; with theoretical considerations of the role alkaline bone mineral may play in the defence against acidosis dating as far back as the late 19th century. Natural, pathological and experimental states of acid loading and/or acidosis have been associated with hypercalciuria and negative Ca balance and, more recently, the detrimental effects of ‘acid’ from the diet on bone mineral have been demonstrated. At the cellular level, a reduction in extracellular pH has been shown to have a direct enhancement on osteoclastic activity, with the result of increased resorption pit formation in bone. A number of observational, experimental, clinical and intervention studies over the last decade have suggested a positive link between fruit and vegetable consumption and the skeleton. Further research is required, particularly with regard to the influence of dietary manipulation using alkali-forming foods on fracture prevention. Should the findings prove conclusive, a “fruit and vegetable” approach to bone health maintenance may provide a very sensible (and natural) alternative therapy for osteoporosis treatment, which is likely to have numerous additional health-related benefits.

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Dr Susan New, fax +44 1483 576978, email s.new@surrey.ac.uk
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LJ Appel , TJ Moore , E Obarzanek , WM Vallmer , LP Svetkey , FM Sacks , GA Bray , TM Vogt & JA Cutler (1997) A clinical trial of the effects of dietary patterns on blood pressure New England Journal of Medicine 336, 11171124.

TR Arnett , A Boyde , SL Jones & ML Taylor (1994) Effects of medium acidification by alteration of carbon dioxide or bicarbonate concentrations on the resorptive activity of rat osteoclasts. Journal of Bone and Mineral Research 9, 375379.

TR Arnett & DW Dempster (1986) Effect of pH on bone resorption by rat osteoclasts in vitro. Endocrinology 119, 119124.

TR Arnett & DW Dempster (1990) Perspectives: protons and osteoclasts. Journal of Bone and Mineral Research 5, 10991103.

TR Arnett & M Spowage (1996) Modulation of the resorptive activity of rat osteoclasts by small changes in extracellular pH near the physiological range. Bone 18, 277279.

US Barzel (1969) The effect of excessive acid feeding on bone. Calcified Tissue Research 4, 94100.

US Barzel (1995) The skeleton as an ion exchange system: implications for the role of acid-base imbalance in the genesis of osteoporosis. Journal of Bone and Mineral Research 10, 14311436.

US Barzel (1996) Ne'ertheless, an acidogenic diet may impair bone (letter). Journal of Bone and Mineral Research 11,704.

T Buclin , M Cosma , M Appenzeller , AF Jacquet , LA Decosterd , J Biollaz & P Burckhardt (2001) Diet acids and alkalis influence calcium retention on bone. Osteoporosis International 12, 493499.

DA Bushinsky , NE Sessler , RE Glena & JDB Featherstone (1994) Proton-induced physicochemical calcium release from ceramic apatite disks. Journal of Bone and Mineral Research 9, 213220.

JF Chiu , SJ Lan , CY Yang , PW Wang , WJ Yao , LH Su & CC Hsieh (1997) Long term vegetarian diet and bone mineral density in postmenopausal Taiwanese women. Calcified Tissue International 60, 245249.

SR Cummings , MC Nevitt , WS Browner , K Stone , KM Fox & KE Ensrud (1995) Risk factors for hip fracture in white women. New England Journal of Medicine 332, 767773.

B Dawson-Hughes , SS Harris & S Finneran (1995) Calcium absorption on high and low Ca intakes in relation to vitamin D receptor genoptype. Journal of Clinical Endocrinology and Metabolism 80, 36573661.

BS Eaton & M Konner (1985) Paleolithic nutrition. A consideration of its nature and current implications. New England Journal of Medicine 312, 283290.

JA Eisman (1999) Genetics of osteoporosis. Endocrine Reviews 20, 788804.

J Green & R Kleeman (1991) Role of bone in regulation of systematic acid-base balance (editorial review). Kidney International 39, 926.

RH Hammond & E Storey (1970) Measurement of growth and resorption of bone in rats fed meat diet. Calcified Tissue Research 4, 291.

RP Heaney , S Abrams , B Dawson-Hughes , A Looker , R Marcus , V Matkovic & C Weaver (2000) Peak bone mass. Osteoporosis International 11, 9851009.

L Irving & AL Chute (1933) The participation of the carbonates of bone in the neutralisation of ingested acid. Journal of Cellular Physiology 2, 157.

JA Kraut & JW Coburn (1994) Bone, acid and osteoporosis. New England Journal of Medicine 330, 18211822.

I Kurtz , T Maher , HN Hulter , M Schambelan & A Sebastian (1983) Effect of diet on plasma acid-base composition in normal humans. Kidney International 24, 670680.

EM Lau , T Kwok , J Woo & SC Ho (1998) Bone mineral density in Chinese elderly female vegetarians, vegans, lactoovovegetarians and omnivores. European Journal of Clinical Nutrition 52, 6064.

J Lemann Jr, RW Gray , WJ Maierhofer & HS Cheung (1986) The importance of renal net acid excretion as a determinant of fasting urinary calcium excretion. Kidney International 29, 743746.

J Lemann Jr, RW Gray & JA Pleuss (1989) Potassium bicarbonate, but not sodium bicarbonate, reduces urinary calcium excretion and improves calcium balance in healthy men. Kidney International 35, 688695.

J Lemann Jr, JR Litzow & EJ Lennon (1966) The effects of chronic acid load in normal man: Further evidence for the participation of bone mineral in the defence against chronic metabolic acidosis. Journal of Clinical Investigation 45, 16081614.

J Lemann Jr, JR Litzow & EJ Lennon (1967) Studies of the mechanisms by which chronic metabolic acidosis augments urinary calcium excretion in man. Journal of Clinical Investigations 46, 13181328.

J Lemann Jr, JA Pleuss , RW Gray & RG Hoffmann (1991) Potassium administration increases and potassium deprivation reduces urinary calcium excretion in healthy adults. Kidney International 39, 973983.

HE Meema (1996) What's good for the heart is not good for the bones? (letter). Journal of Bone and Mineral Research 11, 704.

K Michaelsson , L Holmberg , H Maumin , A Wolk , R Bergstrom & S Ljunghall (1995) Diet, bone mass and osteocalcin; a cross-sectional study. Calcified Tissue International 57, 8693.

R Muhlbauer & Y Li (1999) Effects of vegetables on bone metabolism. Nature 401 343344.

SA New (1998) ‘Fit but Fragile’ – are elite sportswomen at an increased risk of osteoporosis? Nutrition Bulletin 23, 211213.

SA New (1999) Bone health: the role of micronutrients. British Medical Bulletin 55, 619633.

BH Patterson , G Block & WF Rosenberger (1990) Fruit and vegetables in the American diet: data from the NHANES II Survey. American Journal of Public Health 80, 14431449.

SH Ralston (1999) The genetics of osteoporosis. Bone 25, 8586.

MM Reidenberg , BL Haag , BJ Channick , CR Schuman & TGG Wilson (1966), The response of bone to metabolic acidosis in man. Metabolism 15, 236241.

T Remer & F Manz (1995), Potential renal acid load of foods and its influence on urine pH. Journal of the American Dietetic Association 95, 791797.

A Sebastian , ST Harris , JH Ottaway , KM Todd & RC Morris Jr (1994), Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. New England Journal of Medicine 330, 17761781.

A Sebastian , RE Hemandez , AA Portale , J Colman , J Tatsuno & RC Morris Jr (1990), Dietary potassium influences kidney maintenance of serum phosphorus concentrations. Kidney International 37, 13411349.

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Proceedings of the Nutrition Society
  • ISSN: 0029-6651
  • EISSN: 1475-2719
  • URL: /core/journals/proceedings-of-the-nutrition-society
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