Acid-Alkali balance

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Maintaining the correct acidity/alkalinity (or pH) of the blood is an essential part of good health. Acidity and alkalinity is determined by the concentration of hydrogen ions - the lower the pH, the greater the acidity and the greater the concentration of hydrogen ions. It is important to realise the pH scale is a logarithmic one. This means that the difference between a pH of 7 and 4 means a thousand fold increase in hydrogen ions. [This is calculated, in this case, as 7 - 4 = 3 and then raising 10 to the power of 3, giving 1000.] Such a shift would have a massive effect on biochemical processes, most of which are exquisitely sensitive to pH changes. For normal metabolism, the pH of the blood is tightly controlled by the lungs and the kidneys. In the short term the lungs compensate where there is a tendency to acidosis [increased acidity] by slowing breathing so retaining carbon dioxide and increasing bicarbonate, and with that pH. In the medium term the kidneys compensate - where there is acidosis, we pee out acid.

This works fine when we have enough acid or bicarbonate to play with. We run into problems when we don't. Where there is poor mitochondrial function, we slip into anaerobic metabolism and produce lactic acid. This chronic overproduction puts us into a permanently acidic state. This means that any person with a tendency to fatigue and anaerobic metabolism is likely to be chronically acidotic. We try to correct this by peeing out acid, but there is only so much we can do!

I suspect the upper fermenting gut results in an acidosis - sugars may be fermented into acids such as D-lactate to cause D-lactate acidosis. See Fermentation in the gut and CFS

The possible effects of being acidic are:

  • Hypoglycaemia - an acidic body means we cannot release glucose from the liver, nor can we make use of sugar in blood and muscle (glycolysis, that is the conversion of glucose, is inhibited). So mitochondria are further starved of energy and the sufferer craves carbs, feeling ghastly when he does not eat. See Hypoglycaemia - the full story
  • Muscles contract less strongly (see below)
  • Acid urine strips out minerals so we lose minerals too easily. Acidic urine is a risk factor for osteoporosis. See Osteoporosis - practical nutritional considerations
  • Plasma potassium levels may rise

Hyperventilation will worsen any tendency to acidosis because it washes out carbon dioxide, and therefore bicarbonate, from the blood. See Hyperventilation - makes you feel as if you can't get your breath

Muscles and acidity

I suspect there is another effect on muscles. To understand this, think how muscles work. There are two important protein components, namely actin and myosin. They interact like little men rowing a boat. The actin oars are dipped in the myosin water and pull, so shortening the muscle fibre. The oars are lifted out and take another bite of water so the muscle filament is ratcheted shorter. This process depends on the oars being alternately sticky and then letting go. This is dependent on electrical forces. One moment there is attraction and stickiness, next repulsion to let go. These electrical forces are controlled by electrons and protons, i.e. pH is vital! If the pH is wrong, the oars are too sticky, do not let go of the myosin and there is muscle damage. I suspect this acidic tendency clinically is associated with sore muscles, muscle cramps, spasms, tics and restless legs.

Once started on magnesium carbonate, many people comment that their early morning stiff muscles are much improved!

Calcium and acidity

One of the biochemical problems that John McLaren-Howard has identified is a tendency for calcium to build up inside cells. The cells try to tuck it out the way by sticking it on to calcium containing proteins, such as calmodulin, calcium-actin or CaATPase. This is OK in the short term, but eventually these mechanisms become saturated, free ionised calcium rises and inhibits many of the mechanisms for energy production in the cell. This calcium is not responsive to magnesium administration, so what to do about it? We honestly do not know! BUT calcium and hydrogen ions are intimately related and the optimist in me is hoping that an alkaline environment will help correct the biochemical abnormalities. Watch this space!


A useful starting point is to measure urinary pH. You simply measure urine pH with litmus paper. The idea is to get the pH to about 6.5. Urine is meant to be slightly acid- this is a protection against infection -as John McLaren Howard said: "pH means pee Hydrogen ions". Water has a neutral pH of 7.0. Adjust the body's pH with judicious doses of magnesium bicarbonate starting with 1-2 grams at night, but see below! You do not want to upset normal stomach acidity at the wrong time!

One can calculate the acidity of the blood from an anion gap See Wikipedia article on Anion Gap . It should be below 14. Higher than this points to an acidosis.

Acid and alkali in the gut

This is a vital part of sterilising the gut, providing the correct pH for digestion and absorption of food and minerals. We need an acid stomach (pH 4 or below) to kill off the acid sensitive bugs. This acidity also digests protein and controls the emptying of the stomach (see Hypochlorhydria). Food remains in the stomach for 1-2 hours, then empties into the duodenum. Here we need an alkali environment (pH 8, i.e. a 10,000 fold decrease in hydrogen ions. This being calculated as before: 8 - 4 = 4 and then raising 10 to the power of 4, giving 10,000) to kill the alkali sensitive bugs, and allow pancreatic enzymes and bile salts to work to digest fats, carbohydrates and some proteins. Normally, the pancreas secretes this bicarbonate but can only do so if it has the raw materials to play with.

Thus by manipulating the pH in the gut we protect ourselves from infections - something which many PWME* are not good at! Many are helped by taking acid with meals, such as ascorbic acid or betaine hydrochloride. We can help the body further by taking magnesium carbonate to neutralise this acid 1-2 hours after eating food. It is important not to take the magnesium bicarbonate with food or the gut function will be upset. You can check that you are somewhere near by measuring urinary pH. It would be very difficult to overdose with magnesium carbonate since bicarbonates are easily excreted in urine (this leaves magnesium oxide in the gut - a benign substance that helps gut motility). You do not have to be too accurate as the body is very good at compensating so long as it has the basic raw materials to do so.

A traditional remedy is sodium bicarbonate. The problem is this produces a sodium load which, with Western diets, we are often overloaded with. Magnesium carbonate is a good option because magnesium deficiency is common, and magnesium is all too easily excreted. Often people report improved bowel function as a result of the additional magnesium.

Bicarbonate and cancer

Alkalinisation has been described as the poor man's cancer treatment. Western diets are a major risk factor for cancer and most people eating Western diets have a tendency to acidosis.

Bicarbonate and pain relief

This is a traditional remedy for pain relief - most notably cystitis. I now have 2 patients whose gout (see Gout) has been greatly improved by magnesium carbonate - this makes good sense - if the blood is acidic then uric acid is less soluble and more likely to crystallize out in the joints. But it can be effective for other types of pain,also. Indeed I suspect that being acidic lowers the pain threshold - we all know that lactic acid is painful because we feel it after we have had a run or workout - see Wikipedia article on lactic acid.

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I use the term PWME to denote 'People with M.E.'

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