British Journal of Nutrition

Human and Clinical Nutrition

Diet-induced acidosis: is it real and clinically relevant?

Joseph Pizzornoa1 c1, Lynda A. Frassettoa2 and Joseph Katzingera3

a1 PO Box 25801, Bastyr University, Seattle, WA 98165, USA

a2 Division of Nephrology, 12 Moffitt CTSI Clinical Research Center, University of California, San Francisco, CA, USA

a3 Salugenecists, 19531 7th Avenue NE, Shoreline, WA 98155, USA


The concept of diet-induced ‘acidosis’ as a cause of disease has been a subject of interest for more than a century. The present article reviews the history of our evolving understanding of physiological pH, the physiological support for the concept of ‘acidosis’, the causes of acidosis, how it is recognised, its short-term effects as well as the long-term clinical relevance of preventative measures, and the research support for normalisation of pH. Further, we suggest differentiation of the terms ‘acidosis’ and ‘acidaemia’ as a way to resolve the conflation of these topics which has led to confusion and controversy. The available research makes a compelling case that diet-induced acidosis, not diet-induced acidaemia, is a real phenomenon, and has a significant, clinical, long-term pathophysiological effect that should be recognised and potentially counterbalanced by dietary means.

(Received November 05 2008)

(Revised July 06 2009)

(Accepted October 21 2009)

(Online publication December 15 2009)


c1 Corresponding author: Dr Joseph Pizzorno, fax +1 206 368 8570, email


Abbreviations: NAE, net acid excretion; NEAP, net endogenous acid production; PRAL, potential renal acid load