The Hidden Health Crisis: Understanding Bicarbonate Loss

How Modern Living Depletes Our Most Critical Buffer System—And What We Can Do About It

At the core of human health lies a delicate balance that few people consider: maintaining blood pH. While most of us worry about cholesterol, blood pressure, or blood sugar, we rarely think about our blood’s acid-base balance. Yet this invisible factor may be the key to understanding how and why we age—and why chronic diseases develop. Modern living presents unprecedented challenges to this crucial balance, with every aspect of our lifestyle—from the foods we eat to the air we breathe—potentially contributing to bicarbonate depletion. Understanding this critical buffer system becomes increasingly important as we face an epidemic of chronic diseases that may have their roots in disrupted acid-base balance.

Scientists measure our acid-base balance through a marker called Net Endogenous Acid Production (NEAP). NEAP quantifies the total acid load our body must handle daily by calculating the difference between acid and base (alkaline) production from our diet and metabolism. A positive NEAP value indicates net acid production, while a negative value indicates net base production. This measurement helps us understand how diet and lifestyle patterns affect our body’s acid burden.

The Silent Decline

Research reveals a troubling pattern: starting at age 45, our bodies begin losing bicarbonate, one of our most crucial buffering systems. This isn’t just another aspect of aging—mounting evidence suggests it may be a fundamental driver of the aging process itself. By age 90, we’ve lost 18% of our blood bicarbonate, a deficit that forces our bodies into increasingly desperate compensatory measures.

This decline parallels another critical age-related change: starting at age 40, we lose approximately 1% of our kidney function yearly. Since our kidneys play a vital role in producing and conserving bicarbonate, this gradual loss of kidney function directly impacts our ability to maintain proper acid-base balance. By age 60, a person has lost 20% of their kidney function, and by 80, that loss approaches 40%—significantly compromising the body’s ability to regulate bicarbonate levels.

Blood must maintain a precise pH of 7.35 to 7.45 to sustain life. The body will sacrifice almost anything to maintain this balance, including pulling calcium from bones and converting acids into solid forms that can be stored away from the bloodstream. While effective in the short term, this survival mechanism may be at the root of many chronic diseases. As kidney function declines with age, these compensatory mechanisms become increasingly necessary—and destructive.

The Four Stages of Compensation

When bicarbonate levels fall, the body initiates a series of increasingly desperate measures to maintain blood pH within its critically narrow range. These compensatory mechanisms progress through four distinct stages, each more serious than the last, as the body sacrifices long-term health for immediate survival. Understanding these stages helps explain how initial bicarbonate loss can eventually lead to chronic disease development:

Stage 1: Initial compensation: The body first attempts to maintain pH through existing buffer systems. The respiratory system increases its effort to eliminate acid through CO2 exhalation, while the kidneys enhance acid excretion and bicarbonate reabsorption. Cellular buffers work overtime, and protein buffers in muscle tissue become more active.

Stage 2: Alternative buffering: As primary compensatory mechanisms become overwhelmed, the body extracts calcium from bones to neutralize acids. Muscle tissue is utilized more aggressively for buffering, and the kidneys increase ammonia production. Cellular metabolism shifts to reduce acid production.

Stage 3: Acid conversion and storage: This critical stage marks a turning point in health. The body begins converting liquid acids into solid forms, including cholesterol formation in blood vessel walls, fatty acid storage in the liver and adipose tissue, uric acid crystallization in joints, and kidney stone formation.

Stage 4: Disease development: The culmination of these compensatory mechanisms can manifest as chronic disease:

Cardiovascular disease from cholesterol and calcium deposits and subsequent vessel stiffening
Stroke from vessel damage and mineral imbalance
Cancer progression in an acidic tumor microenvironment
Insulin resistance and diabetes from metabolic disruption
Respiratory disease from acid-induced inflammation
Osteoporosis (loss of bone density) from calcium depletion
Sarcopenia (loss of muscle mass) from protein buffer depletion and acid-induced muscle breakdown
Arthritis from crystal deposits and inflammation
Kidney disease from stone formation and acid overload
Fatty liver disease and cirrhosis from acid-induced insulin resistance and metabolic disruption
Gastrointestinal disorders from disrupted digestive enzyme function and inflammation
Depression from pH-disrupted neurotransmitter function
Fibromyalgia from chronic tissue acidosis and inflammation
Alzheimer’s disease from disrupted brain pH and protein folding
Autoimmune conditions from pH-disrupted immune regulation
Sleep disorders from disrupted neurotransmitter and hormone function
Chronic fatigue from cellular energy disruption and acid accumulation
Hormonal imbalances from pH-disrupted endocrine function
Dental degeneration, including tooth demineralization, enamel erosion, cavity formation, periodontal disease, gum recession, root canal susceptibility, and dental abscesses from chronic acidic oral environment, disrupted mineral balance, compromised remineralization, and pH-disrupted oral microbiome

This progressive pattern of compensation and disease development demonstrates how bicarbonate loss may underlie many of our most common chronic conditions. As each stage progresses, the body’s compensatory mechanisms become increasingly destructive, creating a cascade of health problems that can affect virtually every system in the body. Understanding these connections opens new possibilities for prevention and treatment strategies, particularly if we can intervene in the earlier stages before significant damage occurs.

The Protein Paradox

It’s important to understand that acid-forming foods produce acid when metabolized, regardless of their natural pH. In contrast, alkaline-forming foods create an alkaline effect in the body during metabolism, irrespective of their initial pH. Interestingly, some foods that taste acidic (like lemons and limes) are actually alkaline-forming once metabolized. This distinction is crucial for understanding how foods affect our body’s acid-base balance.

Modern diets, particularly high animal protein consumption, create a perfect storm for bicarbonate depletion. Each gram of animal protein creates a double acid burden: approximately 1 mEq of acid from sulfur-containing amino acids plus an additional acid load from its high phosphorus content. Animal proteins contain 20-30 mg of phosphorus per gram of protein, which is converted to phosphoric acid during metabolism. This phosphorus is highly bioavailable, with 60-80% being absorbed, compared to lower absorption rates from plant protein sources.

The problem is multifaceted:

The quantity of animal protein in modern diets
The high bioavailability of phosphorus from animal sources
Additional phosphorus from food additives in processed meats
The combined acid load from both sulfur and phosphorus metabolism
The lack of offsetting alkaline-forming fruits and vegetables in the diet
The cumulative burden on aging kidneys to handle this acid load

This creates a situation where our buffering systems are consistently overwhelmed, not just by the amount of protein consumed but by the multiple sources of acid generation from each gram of that protein. The situation is further compounded by the modern trend toward processed foods, which often contain additional phosphorus-based additives while consuming fewer alkaline-forming foods that could help offset this acid burden.

The Processed Food Problem

Modern food processing methods have created unprecedented challenges for our body’s acid-base balance. This transformation of our food supply, particularly since the advent of agriculture and industrial food processing, has fundamentally altered how our bodies manage pH levels. With processed foods now comprising over 60% of the average American diet, the impact on our bicarbonate buffering systems has become a critical health concern.

Research from the University of California, San Francisco has quantified this dramatic dietary transformation by studying the theoretical combinations of pre-agricultural diets and real-world observations of modern hunter-gatherer societies. The researchers found that hunter-gatherer diets—both ancient and in surviving traditional societies like those in New Guinea—produced -88 mEq of acid per day (base-producing). In comparison, the modern American diet produces +48 mEq of acid per day (acid-producing). This represents a massive swing of 136 mEq/day toward acid production. The researchers’ findings were validated by observations of New Guinean hunter-gatherers living traditional lifestyles, whose urine pH typically ranged between 7.5 and 9.0—remarkably alkaline values that can only be achieved through a strongly base-producing diet rich in potassium bicarbonate and potassium citrate.

The transformation of our food supply has created multiple disruptions to our natural acid-base balance:

The displacement of high-bicarbonate-yielding plant foods (roots, tubers, leafy greens, fruits) with cereal grains and energy-dense, nutrient-poor foods
Refined sugars trigger acid-generating metabolic reactions while lacking the buffering minerals and fiber found in whole fruits
The absence of essential nutrients (magnesium, potassium, B vitamins, fiber) compromises natural acid-buffering and elimination capabilities
Industrial processing methods strip foods of natural acid-buffering compounds while introducing acidifying preservatives and additives
High sodium content forces kidneys to prioritize sodium regulation over acid excretion, raising blood pressure, disrupting mineral balance, and impairing bicarbonate reabsorption
Industrial fats and oils promote inflammation that increases cellular acid production, compromises tissue buffering, and creates a self-perpetuating cycle of acidosis

The introduction of harmful additives presents another layer of complexity. Modern processed foods contain acidifying preservatives, additional phosphorus-based additives, and industrial fats and oils that promote inflammation. The high sodium content in these foods forces kidneys to prioritize sodium regulation over acid excretion, raising blood pressure, disrupting mineral balance, and impairing bicarbonate reabsorption. Refined sugars trigger acid-generating metabolic reactions while lacking the buffering minerals and fiber found in whole fruits, further contributing to the acid burden.

Combining these dietary changes creates an acid burden far greater than these components would produce individually. This effect often overwhelms our natural buffering systems, particularly as kidney function naturally declines with age. The body must constantly work to neutralize acids, leading to increasingly destructive compensatory mechanisms as natural buffering systems become depleted. The body’s need to maintain blood pH between 7.35 and 7.45 forces it to extract calcium from bones, increase kidney stress, and sacrifice muscle mass while promoting chronic inflammation.

These compensatory mechanisms can eventually lead to the development of various chronic diseases, including cardiovascular disease, diabetes, osteoporosis, kidney disease, and numerous other conditions. The processed food burden becomes the tipping point that pushes our buffering systems into a state of chronic depletion—a stark contrast to our ancestral diet, which was predominantly alkaline-producing.

To mitigate these effects, several key dietary changes can be implemented. Increasing the consumption of vegetables and fruits while limiting grain intake and choosing whole foods over processed ones can help restore a more natural acid-base balance. Maintaining proper hydration and monitoring urine pH as an early warning system can provide valuable feedback about the body’s acid-base status. Some individuals may benefit from appropriate supplementation under healthcare provider supervision. Understanding these relationships between processed foods and acid-base balance enables more informed dietary choices to help maintain optimal pH levels and potentially reduce the risk of chronic health conditions.

Chronic Dehydration

Water is fundamental to every aspect of human physiology, playing a crucial role in maintaining acid-base balance through its effects on cellular function, waste removal, and bicarbonate regulation. Despite its critical importance, chronic dehydration has become endemic in modern society, affecting an estimated 75% of Americans. This silent disruption of our body’s fluid balance creates a cascade of effects directly impacting our bicarbonate buffering systems and overall health. When the body lacks adequate water:

Blood becomes more concentrated, requiring more bicarbonate to maintain proper pH
Kidney function becomes compromised, reducing acid excretion
Cellular waste removal slows, allowing acid buildup
The lymphatic system becomes sluggish, impairing acid transport
Thirst signals become blunted, particularly with age
Concentrated urine allows acid to crystallize more readily
Bicarbonate reabsorption becomes less efficient

The situation becomes particularly problematic because many people replace water with acid-forming beverages like coffee, black tea, sodas, and alcohol, further burdening our buffering systems. Not only are we failing to provide the water necessary for optimal bicarbonate function, but we’re actively introducing additional acid loads that further tax our already stressed buffering capacity. Chronic dehydration and acid-forming beverage consumption represent one of the most significant yet easily modifiable factors affecting our acid-base balance.

Medication Impact

In our modern medical system, pharmaceutical interventions have become increasingly common, with nearly 70% of Americans taking at least one prescription medication and 20% taking five or more. While these medications often provide essential therapeutic benefits, their impact on acid-base balance is rarely considered in clinical practice. Many commonly prescribed drugs can significantly affect bicarbonate levels through increased exposure to acidifying agents and by impairing our body’s regulatory mechanisms:

Diuretics deplete bicarbonate through increased urinary excretion
Proton pump inhibitors reduce stomach acid, affecting bicarbonate generation
Blood pressure medications can alter kidney function and bicarbonate regulation
Some antiseizure medications directly inhibit bicarbonate transport
Chemotherapy drugs may damage kidney function and buffering capacity
Antibiotics can affect kidney function and acid-base regulation
Non-steroidal anti-inflammatory drugs (NSAIDs) may impact kidney bicarbonate handling
Antacids containing aluminum or calcium can interfere with bicarbonate absorption

The challenge becomes particularly significant when multiple medications are taken simultaneously, as is common in aging populations. This polypharmacy effect can create a compounding burden on our buffering systems, especially as kidney function naturally declines with age. Each additional medication not only brings its own potential impact on acid-base balance but can interact with other drugs to create effects greater than the sum of their parts. This medication-induced stress on our buffering systems represents a critical but often overlooked factor in the progression of age-related diseases and the acceleration of the aging process itself. Healthcare providers must consider these effects when prescribing medications, particularly for older adults or those with already compromised buffering capacity.

Modern Living: A Recipe for Acidosis

The modern lifestyle presents an unprecedented assault on our body’s acid-base balance. Never before in human history have we faced such a complex combination of factors that deplete our bicarbonate reserves. While poor diet, underhydration, and medication effects are significant, they represent only part of a larger pattern of acid-generating challenges that characterize contemporary living. Understanding these factors is crucial because they often work synergistically, creating a burden far more significant than their individual effects would suggest. Beyond diet, hydration, and medication, several aspects of modern life accelerate bicarbonate loss:

Physical inactivity: Sedentary behavior reduces circulation and lymphatic flow, impairing acid clearance and reducing our natural buffering capacity.
Stress and lack of sleep: Chronic stress and poor sleep patterns increase acid production while compromising our ability to regulate pH balance.
Environmental toxins: Tobacco and alcohol consumption, microplastics, and the tens of thousands of man-made chemicals in the air, water, food and food packaging, household and personal-care products, and clothing fabric. They can all affect acid-base balance and bicarbonate levels through exposure to acidifying agents.
Altitude exposure: Higher altitudes trigger respiratory compensation through increased breathing rate, depleting bicarbonate reserves as the body attempts to maintain oxygen levels and pH balance. Our hunter-gatherer ancestors generally lived at lower elevations. They preferred areas rich in resources, such as rivers, lakes, and forests, which provided ample food and water sources. These environments supported a variety of plant and animal life, making it easier for them to hunt, fish, and gather food. Higher elevations, on the other hand, tend to be more challenging due to harsher climates and less vegetation. While some hunter-gatherer groups inhabited higher altitudes, they were more common in lower, resource-rich areas.
Gut dysbiosis: A dysfunctional gut microbiome can alter the metabolism of dietary proteins and minerals, compromise the absorption of acid-buffering minerals, increase intestinal inflammation and acid production, affect the body’s ability to properly regulate acid-base balance through altered metabolite production, and create additional acid burden through bacterial fermentation products.

This complex interplay of modern lifestyle factors creates a perfect storm for bicarbonate depletion. Unlike our ancestors, who faced primarily acute stressors with recovery periods, we experience chronic, continuous exposure to these acid-generating conditions. Recognizing these challenges is the first step toward implementing effective countermeasures to protect our acid-base balance and, ultimately, our health.

Measuring What Matters

Our body’s fluid systems operate in distinct compartments, uniquely influencing acid-base balance. While blood pH must remain tightly regulated between 7.35 and 7.45, a separate fluid environment exists called the extracellular fluid compartment. This compartment is a critical buffer zone between our cells and blood.

The extracellular fluid compartment is the aqueous environment that bathes and nourishes our cells, tissues, and organs. This fluid, separate from but interconnected with our blood vessels, is four times the volume of our blood. It serves as a nutrient delivery system and a temporary holding space for acids before they can be processed and eliminated. While blood pH cannot vary without severe consequences, the pH of the extracellular space can fluctuate widely, ranging from 4.5 to 8.0. In an optimal state, when the body has sufficient buffering capacity, the pH of the extracellular fluid should mirror that of blood. However, as buffering capacity diminishes, this compartment becomes increasingly acidic, serving as an early warning system for developing acid-base imbalances.

Standard blood chemistry panels include a CO2 measurement, which primarily reflects serum bicarbonate levels. While the normal range typically falls between 23-29 mEq/L, values within this “normal” range don’t necessarily indicate optimal buffering capacity. Blood maintains its narrow pH range by sacrificing other systems, meaning normal blood values may mask significant bicarbonate depletion in the extracellular fluid compartment. This is why the CO2 measurement often remains normal until buffering systems are severely compromised. Other relevant markers include chloride (which maintains an inverse relationship with bicarbonate), anion gap (which can indicate metabolic acidosis), and electrolyte levels that reflect mineral status.

Urine pH provides a more sensitive window into this extracellular fluid environment, offering valuable insights about our body’s acid-base status that blood tests might miss. Because the kidneys filter fluid from this compartment to make urine, urine pH reflects the acid load in our extracellular space rather than our blood. Regular monitoring of urine pH can reveal:

Chronic acid load (consistently low pH below 6.0)
Overnight acid accumulation (morning pH below 6.0)
Meal-related acid stress
Buffer depletion (inability to achieve pH above 6.5)

These measurements help us understand how well our body manages acid loads from various sources and whether our buffering systems are becoming overwhelmed. Unlike blood tests that show only the final, tightly regulated result, urine pH gives us early warning signs of developing acid-base imbalances. This early detection capability makes urine pH monitoring a valuable tool for prevention and treatment strategies, allowing us to identify and address acid-base disruptions before they manifest as serious health problems. Regular monitoring can help guide lifestyle modifications and intervention strategies, providing a practical way to assess their effectiveness in maintaining optimal acid-base balance.

Solutions for Modern Living

Maintaining healthy bicarbonate levels requires a comprehensive approach that addresses multiple aspects of daily living. While each component has value on its own, the real power lies in their synergistic effects when implemented together. Just as various factors contribute to bicarbonate loss, a coordinated approach to prevention and treatment can help restore and maintain our vital buffering systems:

Dietary Measures:

Reduce or eliminate animal protein
Minimize processed food intake
Eat meals that limit acid-forming foods and beverages and favor alkaline-forming ones: a) Alkaline Vegan Cookbook, b) The Essential Alkaline Diet Cookbook, and c) The 21-Day Alkaline Diet Plan.
Stay well hydrated throughout the day
Consider bicarbonate supplementation if indicated and under healthcare provider supervision with regular monitoring

Movement Strategies:

Engage in regular physical activity
Include resistance training
Take frequent movement breaks throughout the day
Perform evening activities supporting lymphatic function
Maintain consistent daily activity patterns

Rest and Recovery:

Adhere to a consistent sleep schedule
Implement effective stress management techniques
Practice regular relaxation
Incorporate proper breathing exercises
Prioritize restorative activities

Environmental Awareness:

Improve air quality in living and working spaces
Reduce exposure to acidifying chemicals and toxins
Eliminate alcohol consumption
Quit smoking
Minimize exposure to environmental pollutants
Create clean-air zones in living spaces

By implementing these strategies systematically and consistently, we can work to maintain optimal bicarbonate levels and support our body’s natural buffering systems. Success comes not from perfect adherence to any single measure but from the cumulative effect of these various approaches working together to support acid-base balance. The key is to start gradually, implementing changes sustainably that can be maintained long-term while recognizing that even minor improvements in multiple areas can significantly positively affect overall bicarbonate status. This patient, systematic approach allows us to build lasting habits that protect our buffering systems throughout life.

Looking Forward

Future research continues to explore individual susceptibility to acid accumulation, optimal intervention strategies, and early warning signs of buffer depletion. Understanding and addressing bicarbonate loss may be critical to preventing chronic disease and supporting healthy aging. The path to optimal health requires understanding this complex interplay between bicarbonate status, lifestyle choices, and disease development. By addressing these factors systematically, we can work to maintain the crucial pH balance that underlies all aspects of health.

References

The Hidden Health Crisis: Understanding Bicarbonate Loss

Dr. Daniel Thomas, DO, MS