Your Friday Dose of Woo: Acid, base, or woo?

It's about time it was Friday. No, it's not because it will mean any less work for me; in fact, this weekend will probably mean more, as I have to go to a workshop that's more like boot camp. It's more because the subject matter of this blog had become such a major bummer, with the fifth anniversary of September 11, followed by a rumination about aging, followed by two posts about the dismal funding situation at the NIH. The only thing breaking up the gloom was getting a chance to point out a lovely deconstruction of an HIV "skeptics'" misguided attempt at claiming the mantle of skepticism, which led to my being called low rent riff raff by Celia Farber herself. Things have clearly gotten too serious around here

And that makes it a good time for some woo.

I bet you didn't know just how important your body pH is to the proper functioning of health. Heck, medical science even admits it, pointing out that your serum pH is generally regulated within a very tight range. What I bet you didn't know is that you can manipulate your own pH to "optimize" your health. Know how I know it?

Alties tell me so:

Over acidity, which can become a dangerous condition that weakens all body systems, is very common today. It gives rise to an internal environment conducive to disease, as opposed to a pH-balanced environment which allows normal body function necessary for the body to resist disease. A healthy body maintains adequate alkaline reserves to meet emergency demands. When excess acids must be neutralized our alkaline reserves are depleted leaving the body in a weakened condition.

The concept of acid alkaline imbalance as the cause of disease is not new.

Of course it isn't. No altie concept is new (with the possible exception of Hulda Clark's claim that all cancer is caused by an intestinal fluke). At best, they represent early 20th century ideas, most of which have been supplanted as science marches on, but in reality most altie concepts represent 18th or 19th century medicine at best. That's if you're lucky; much of it represents ideas that are thousands of years old. Heck, to these guys, Paracelus is the height of medical authority. Here's an example:

In 1933 a New York doctor named William Howard Hay published a ground-breaking book, A New Health Era in which he maintains that all disease is caused by autotoxication (or "self-poisoning") due to acid accumulation in the body:

Now we depart from health in just the proportion to which we have allowed our alkalies to be dissipated by introduction of acid-forming food in too great amount... It may seem strange to say that all disease is the same thing, no matter what its myriad modes of expression, but it is verily so.
William Howard Hay, M.D.

More recently, in his remarkable book Alkalize or Die (see recommended reading), Dr. Theodore A. Baroody says essentially the same thing:

The countless names of illnesses do not really matter. What does matter is that they all come from the same root cause...too much tissue acid waste in the body!
Theodore A. Baroody, N.D., D.C., Ph.D.

Uh-oh. Here we go again. It all comes down to "toxins" accumulating in your body being the cause for all disease and how you have to eliminate these toxins. I'm feeling a sense of déjà vu here.

I wonder why.

So what can you--yes, you!--do about your own "body" pH? Well, if you believe guys like this (and you know my opinion whether you should believe guys like this), quite a lot. Indeed, there is a veritable cornucopia of foods and supplements that you can supposedly use to manipulate your body pH. Now, given the concept of "toxins" causing acid buildup, due, of course, to our decadent Western lifestyle:

The reason acidosis is more common in our society is mostly due to the typical American diet, which is far too high in acid-producing animal products like meat, eggs and dairy, and far too low in alkaline-producing foods like fresh vegetables. Additionally, we eat acid-producing processed foods like white flour and sugar and drink acid-producing beverages like coffee and soft drinks. We use too many drugs, which are acid-forming; and we use artificial chemical sweetners like NutraSweet, Equal, or aspartame, which are extremely acid-forming. One of the best things we can do to correct an overly-acid body is to clean up the diet and lifestyle. Refer to the recommended reading for specific help with diet and lifestyle.

And what would that "help" be? Well, looky here:

1. Enzymes are essential: Take 1-2 capsules of Food Enzymes or Proactazyme Plus with every meal. Also take 1-2 capsules of High Potency Protease and Nature's Noni between meals on an empty stomach.
2. Correct easily absorbable magnesium is needed: Take 2 Magnesium Complex with each meal which provides highly absorbable magnesium to help build necessary buffers. Magnesium is often lost in urine as a consequence of too much acid in the body. If your urine is 5.8-7.2 take Skeletal Strength as directed to support healthy bones.
3. Alkaline minerals are essential: Take 1 ounce of either Colloidal Minerals or Mineral Chi Tonic once daily.
4. Alkalize with Green Food: Take 1 teaspoon of Liquid Chlorophyll in water up to eight times daily.
5. Vitamin A & D hold calcium in the body. Taking NSP's Vitamin A & D will help the body buffer acid.
6. What if my pH is still too acidic? Use Coral Calcium according to label instructions if slaiva pH is 5.8-6.5. Use Coral Calcium cautiously if pH is below 5.8. Monitor your pH daily.
7. Cleanse as needed: Take a psyllium hulls supplement such as Psyllium Hulls Combination at bedtime to maintain regular bowel movements. Use CleanStart twice a year for liver, bowel and kidney detoxification.

And, of course:

Get the book! Get a copy of the book Alkalize or Die by Dr. Baroody (see recommended reading below) and carefully follow his dietary recommendations choosing more foods that are alkaline-forming and less that are acid-forming.

Heh. "Alkalize or die"? Does that mean if I don't start popping bicarbonate tablets, I'm doomed? But get a load of some of the reasoning used by a different purveyor of acid-base woo to justify going to great lengths to "balance" your pH:

Proper pH balance is much like the balance of light. Clear, bright, white light comes from a perfect balance of every color in the spectrum. If there is any imbalance in the spectrum of colors, the light will no longer be clear. In the same way, pH Balance is achieved by the synergy between each and every element and nutrient that the body needs.

No single element can bring the body into balance, but when the body has all of the raw materials it needs to function and an optimal inner environment, balance is realized.

[...]

When you experience the magic of pH balance, you'll rediscover vibrant health and energy. A body in balance is full of vitality, and is lean and trim. You'll find that you have mental clarity, and you'll even notice that your skin has regained that healthy glow. Simply put, a body in balance functions properly, and operates optimally.

The good news is that if you've suffered the negative impact of an overly acidic body, you can regain your health - you can regain balance.

Geez. pH balance is like light? Geez, apparently "balancing" your pH unbalances your sense of reason. Note the near religious faith in the "magic" of pH balance. And it is magic, but not in the way the author intends; rather, it's a great example of magical thinking. It is, however, good for the pocketbooks of all sorts of alties selling things to fix what for most people is a nonexistent problem. So, is there anything to any of this?

Not really. In fact, they make errors that are rather laughable. For example, if you believe them, you might think that the range of "healthy body pH is from 6.0 to 7.5:

There's a word to describe someone with a blood pH of 6.0 or lower: dead. There's also a word for someone with a blood pH of 7.0: in deep shit. (OK, three words; you can substitute "at death's door" or "in deep doo-doo" if you don't want to use any words the least bit profane.) I can only remember a couple of patients in whose care I've been involved whose pH fell to 7.0 who survived, and they reached that pH during a code. In fact, your blood pH is very tightly regulated between 7.35 and 7.45. There's quite a rational chemical explanation for this. pH measures the hydrogen ion concentration by a log scale and is the -log[H⁺]. What that means is that a one unit change in pH means a 10-fold change in H⁺. The body has very elaborate systems that involve the lungs and kidneys to maintain your body's pH within this very tight range:

Both pulmonary and renal function maintain blood pH within this range. Respiratory changes in minute ventilation occur quickly in response to acid-base disturbances and rapidly alter blood pH by changing carbonic acid concentration through changes in blood PCO2. The kidneys vary the renal excretion of acid or base equivalents and ultimately alter plasma HCO3- concentration to alter blood pH. Renal adaptations to changes in acid-base balance occur over several days while respiratory-driven changes generally occur in minutes to hours. Both pulmonary and renal function act to compensate for disturbances in acid-base balance to maintain blood pH within normal ranges.

Wide fluctuations in H+ concentration are also prevented by the presence of several pH buffers. These buffers are weak acids that exist in equilibrium with the corresponding base at physiologic pH. Buffers respond to changes in [H+] by shifting the relative concentrations of the buffer and the corresponding base to dampen the change in pH. Phosphates; ammonia; proteins, including hemoglobin; and bone all provide pH buffering capacity, but the major pH buffer in the blood, and that which is most relevant to clinical acid-base disturbances, is the bicarbonate/carbonic acid system.

One problem is, at least in this article, these guys seem see urine and saliva pH as representative of the state of "body pH." The two are not the same. For one thing, unlike the urine, saliva is not used by the body to get rid of excess acid or base. For another thing, although the pH of your urine can indeed range from 4.5 to 8.0 (nearly four orders of magnitude difference in H⁺ concentration), urine pH is not body pH. In fact, you can't really control the pH of most of your bodily fluids, particularly blood and extracellular fluid. Urine is one exception, and this is the very reason why the "remedies" sold by the pH fetishists appear to work. For example, dairy products, eggs, and foods with a lot of protein, like meats, will indeed acidify your urine, mainly because the kidneys will secrete the excess acid that is generated when the excess protein is broken down. Your blood pH changes minimally if at all. For a more detailed discussion of the mechanisms controlling your body's acid-base balance, go here, here and here.

The bottom line is that, in the absence of renal and lung disease, the homeostatic mechanisms controlling the pH of your blood are incredibly robust and tightly regulated. (One reason dialysis patients become acidotic is because their kidneys can no longer regulate bicarbonate concentration in the blood.) It's very hard to alter your blood pH by very much for very long, although you can change it briefly (for example, hyperventilation will cause a transient and sometimes quite impressive alkalosis). Indeed, when these homeostatic mechanisms fail, the resulting acidosis or alkalosis is caused by this failure. Trying to reverse an acid-base disturbance is not usually possible without reversing the underlying cause. It won't matter how much alkali you administer; without reversing the underlying cause, the acidosis will return as soon as you stop giving it. In fact, if a patient receives an intravenous bicarbonate infusion to alkalinize the urine, blood pH will change little, unless you infuse a dangerously high amount. The kidney excretes the extra bicarbonate (the intended effect), and hypoventilation shifts the balance from bicarbonate to carbonic acid. Funny that alties, who so decry "conventional medicine" for treating the symptoms, rather than the "underlying causes" of disease would fall prey to such the same mistake they accuse us conventional doctors of. (No it isn't.) Oh, there are a few indications for alkalinization of the urine, like the treatment of certain kinds of kidney stones, but these indications are pretty few.

But what's really hilarious is to listen to the attempted rebuttal of such criticisms of acid-base woo. When Dr. Gabe Mirkin debunked some of this silliness using arguments similar to those above, the woo struck back:

Dr. Mirkin assumes that as long as your body fluids are within that normal range everything is fine. This is a common medical problem - assuming that lack of death and disease is the same as optimum health. Health is not all or nothing. There are varying degrees of healthy. For example, doctors might define high blood pressure as a diastolic BP greater than 90. So if you are 89, they will say that you are healthy. But is a BP of 89 as healthy as a BP of 80? Of course not. Is your body pH as healthy when it is toward the acid end of that "very narrow range" as it is when it is at the optimum point within the middle of that "very narrow range"? Of course not. But Dr. Mirkin makes the assumption that it is. I believe that he knows better, but is deliberately trying to mislead.

"Quackwatch" always assume that lack of obvious disease and symptoms is synonymous with optimal health. They constantly use this kind of faulty logic as an excuse to claim that alternative therapies are unnecessary. But we know the truth: That health means more than the absence of disease. Health is an optimal state of well being, not simply a state borderlining death.

What a load of crap! Dr. Mirkin said nothing of the sort. He simply pointed out that there is no credible evidence that intentionally alkalinizing your own urine prevents or treats disease, makes you feel better, or anything else that the acid-base woos claim. And, in fact, the above analogy is specious. For one thing, no doctor assumes that a diastolic BP of 89 is "healthy" while a BP of 90 is automatically hypertension. Helloooo! Calling Mr. Straw Man! In fact, calling Mr. and Mrs. Strawman, because conventional medicine does not assume that lack of obvious disease and symptoms is synonymous with optimal health. In fact, my irony meter just about exploded when I read that statement because one of the things alties criticize "conventional medicine" for is that it "invents" diseases that need treatment (and, of course, big pharma provides the necessary drugs and thereby reaps the profits). This particular altie is saying that lack of obvious disease and symptoms is not necessarily synonymous with good health.

I couldn't have said it better myself, evil minion of evidence-based medicine that I am.

The difference, of course, is that in conventional medicine if you're going to advocate treating asymptomatic patients to prevent future disease, to make them "feel better," or to "improve health," you actually have to produce convincing scientific and clinical evidence that whatever it is that you are measuring in an asymptomatic patient (blood pressure, for example) correlates with disease and that your proposed intervention will indeed prevent the disease disease correlated with that measure, improve health, and/or prolong life. There is abundant evidence for such benefits, for example, for the treatment of asymptomatic hypertension, hypercholesterolemia, etc. There is no credible evidence that alkalinizing or acidifying your urine will provide similar benefits--or any benefit at all. Remember, we're talkiing very small differences in blood pH at best, even with significant intervention. All you're really doing with these diets, supplements, and minerals is altering the urine pH, in essence pissing out the alkali as the body gets rid of what its pH regulator perceives as excess base. Yes, the increase in urine pH gives you evidence that this woo is "working," but "working" doesn't really do anything that matters.

Of course, no bit of woo would be complete without this:

My advice is to stay away from "quackwatch" and other self-proclaimed "quack busters." My experience is that they always have a hidden agenda, notably protecting the financial interests of the drug industry by casting aspersions on their competition - the alternative health care industry. If they would stick with the truth that would be fine. But they are constantly misrepresenting the facts and perpetuating outright lies in order to further their hidden agenda. It is not the place to find the truth.

Bwahahahahahahaha!

Of course, I would turn it around to this much more accurate statement: "My advice is to stay away from these "acid-base" alties and other self-proclaimed "detoxifiers" and the websites on which they promote their treatments. My experience is that they always have a hidden agenda, notably protecting their financial interests by casting aspersions on their competition and those who are interested in preventing people from being victimized by dubious medical practices - the "conventional" health care industry. If they would stick with the truth that would be fine. But they are constantly misrepresenting the facts and perpetuating outright lies in order to further their hidden agenda of selling supplements and other woo. It is not the place to find the truth."

There. That's much better.