The Role of Acid-Base Balance in Health. Podcast with Dr. Lynda Frassetto

Guest

On this episode of humanOS Radio, I speak with Lynda Frassetto. Lynda is a Professor Emeritus of Medicine in the Division of Nephrology at UCSF. During her research career, she and her colleagues investigated regulation of acid-base balance in both healthy and older people, as well as dietary influences on acid-base balance.

In particular, she has explored how the ratios of potassium to sodium, as well as base to chloride, differ in the modern diet versus the ancestral diet, and how these changes may be linked to greater risk of chronic disease as we get older.

Anthropological evidence suggests that ancient hominids consumed far less sodium and far more potassium, and specifically more potassium alkali salts (primarily from wild plants). The reduction in potential base in the modern diet increases the net systemic acid load, and this in turn may take a physiological toll in myriad ways. Chronic acid load appears to play a role in osteoporosis, hypertension, cardiovascular disease, and even age-related decline in growth hormone secretion.

And this isn’t merely speculation based on our incomplete suppositions about paleo diets. There is compelling evidence from controlled studies that seem to suggest that increasing potassium intake, either through the diet or through potassium supplements, may have major benefits for health and longevity.

For example, one trial randomly assigned elderly Taiwanese veterans in retirement homes to take their meals either at a kitchen that used potassium-enriched salt (experimental group) or a kitchen that used regular old sodium chloride (control group). After 31 months, the experimental group had a 76% boost in potassium intake and a 17% reduction in sodium intake, which was accompanied with a 40% reduction in cardiovascular mortality.

Sounds pretty good. So, which nutritional components determine whether a diet is net acid-producing? And what can we do about it on an individual basis? Should we take potassium supplements to rectify the imbalance? Could restoring a healthy sodium to potassium ratio be a hidden anti-aging tool?

To learn about how you can live a more alkaline life, check out the interview below!

Interview Timeline Topics

00:54 – Show intro by Dan.

01:48 – Dan introduces Dr. Lynda Frassetto.

03:16 – Lynda talks about her background and area of expertise.

04:37 – Ratio of sodium to potassium in our diet – then vs now, high vs low.

07:33 – Recommended daily intake of potassium vs Paleo diet.

08:44 – RDI of sodium, and low sodium diet vs average sodium intake in the typical American diet.

10:16 – Discussion on the DASH diet.

11:15 – Difficulties in following a low sodium diet.

11:56 – Any paradoxical data on a high sodium diet?

13:00 – Lynda emphasizes the importance of lifestyle.

14:28 – Lynda shares some personal tips for salt replacement in cooking.

15:11 – Fundamentals of net acid-producing diet – a deep dive.

19:49 – The aging process – telomeres and klotho.

21:21 – What is klotho?

22:47 – Connection between salt intake and high blood pressure.

26:16 – Supplementing with sodium bicarbonate and potassium bicarbonate.

28:55 – Current state of human & animal studies, and Lynda’s opinion on supplements.

30:56 – Does sodium bicarbonate supplementation benefit athletes?

32:33 – Lynda’s future studies – looking at the effects of low acid diet on polycystic ovarian syndrome.

33:06 – Show outro by Dan.

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Transcript

Lynda Frassetto — 00:04: A low sodium diet would be about 2000 milligrams of sodium, and if you look at the few remaining hunter gatherers in the world, in fact their sodium intakes are extremely low. One servings of Campbell soup is 1000 milligrams, so if you have just one serving of soup, you've already had half of your sodium intake. On a low sodium diet, and in my experience where we were doing 24 hour urines on people just to kind of see how much sodium they were eating, typically it's like 5 to 7000 milligrams of sodium on average.

Kendall Kendrick — 00:46: Human OS learn, master achieve.

Dan Pardi — 00:53: Many believe that a modern contributor to chronic disease in industrialized populations, in other words people like you and me, is a mismatch between our current dietary patterns and our fundamental nutritional needs that were shaped over the slow course of human evolution. Some elements of this mismatch are pretty obvious, like the refinement of Whole Foods into purified ingredients, which are then reconstituted into delicious foods that have fantastic shelf lives. Simply put, for most of our time on this planet as a species, such foods simply did not exist.

But other dietary aspects of mismatch are more subtle, like shifts in the ratios of electrolytes as well as the amount of acid precursors versus base precursors in the diet. But just because these changes are less obvious doesn't mean that they don't have a profound effect on our health, especially as we get older.

That is why I'm pleased to have Lynda Frassetto on the show today. Lynda is a professor emeritus of medicine in the Division of Nephrology at the University of California, San Francisco, or UCSF. During her research career, she and her colleagues investigated regulation of acid base balance in both healthy and older people, as well as dietary influences on acid base balance. In particular, she explored how the ratios of potassium to sodium, as well as base to chloride, differ in modern diet versus the ancestral diet, and how these changes may be linked to greater risk for chronic disease as we get older.

It is thought that ancient hominids consumed far less sodium and far more potassium, and specifically more potassium alkali salts. The reduction in potential base in the modern diet increases the net systemic acid load and this may take a physiological toll in myriad ways. Chronic acid load may play a role in osteoporosis, hypertension. Cardiovascular disease and even age-related decline in growth hormones accretion.

So why specifically is the contemporary diet so lopsided in this respect, at least relative to the ancestral condition? Which nutritional components determine whether a diet is net acid producing and what can we do about it on an individual basis to answer these questions? Lynda, welcome to the show.

Lynda Frassetto — 03:12: And thank you for inviting me. I'm really pleased to be here.

Dan Pardi — 03:15: That's great to hear. Tell us more about your background and your area of expertise.

Lynda Frassetto — 03:21: I am a kidney doctor, and as part of the things that kidneys do, one of the things they do is they decide how much sodium and potassium you need. So all kidney doctors need to know about sodium and potassium. And then another thing the kidneys do is they get rid of extra acid or bicarbonate and they're the final arbiters. Of the actual acid base balance in the body, and therefore anybody who does kidney medicine needs to know something about this. But what we studied was not so much what happens in people with advanced kidney failure, where we know there are problems, but what happens in people who are healthy but maybe otherwise older, who have some decline in their kidney function just because they're older. Does that make a difference in over decades? Does it matter when you're 5060 or 70 years old, if you've spent decades eating a high acid diet and maybe you weren't getting rid of all of the acid that was in your system? So that's really what we looked at.

Dan Pardi — 04:37: Let's talk about how much people are currently consuming and how this then contrasts with the ancestral intake. How much potassium, for example, do we consume now and how much did we consume back in the day?

Lynda Frassetto — 04:49: Let me just switch around and 1st let's talk about sodium. Ok. And the reason I want to do that is because natural foods contain very little sodium chloride and therefore that means that almost all the sodium chloride in our diet and that's table salt. We add, OK, it's a preservative. We like the way it tastes, so we eat a lot of salt. In fact, if you try to put somebody on a low salt diet, it's really difficult because not only do you have to tell them not to add salt to their food, but they actually need to look at all of the foods that they're eating. And when they go to the supermarket, if it's been processed in any way, they need to look to see how much sodium is on the label. It's really hard to avoid sodium. In our diets. So everybody, unless you are really trying hard, is going to be eating a lot more sodium. So it's really difficult to avoid. That means if you talk about the ratio of potassium to sodium in the modern diet, you automatically start out with there's more sodium in the diet. Yeah, and then let's go to potassium is an intracellular ion. There's a lot of potassium, especially in many types of fruits and vegetables, although again, it's found inside of cells. So it's found inside of everything, for example, in the patients that we try to put on a low potassium diet and these are people with advanced kidney failure. We tell them to specifically limit things like tropical fruits and tomatoes and potatoes and legumes, things that particularly contain a lot of potassium. And yet if you're telling people that if in the hunter gatherer diet they ate anything that they could find, and they ate a lot of plant foods, then pretty much automatically they would eat a lot of potassium. And then also if you look at processed foods, most of those are made from grains, cereals or you know, whatnot, and those contain relatively low amounts of potassium. So when you look at percentage of calories in the American diet, a lot of those calories come from cereals and junk food and so automatically that's a low potassium content.

Dan Pardi — 07:15: If I'm remembering correctly, there was some statistic that was somewhat horrifying that 60 % or 80 % of calories come from grain based desserts in the United States.

Lynda Frassetto — 07:26: Yeah, as opposed to, let's say, meat or fish or vegetables or fruits right what is the recommended daily intake for potassium and then what is the Paleolithic intake?

Lynda Frassetto — 07:40: At least in the United States it's forty seven hundred milligrams. And depending on what country you live in, at least in the United States it's more about 3000 milligrams that people take. And so very few people in the United States eat the recommended daily intake for potassium.

Dan Pardi — 08:01: I remember in our smoothie course that it was. 1 to 3 % of the United States actually is meeting this recommended daily intake, which is striking and so that paleolithic style diet, how much potassium would you consume in that scenario?

Lynda Frassetto — 08:16: My old boss Tony Sebastian wrote a paper where he looked at percentages of foods that would have made-up a Paleo diet, and so kind of depends on the percentages. Like are you getting more of a percentage from plant foods as opposed to animal foods? But it was about three times as much as in the American diet on average. That's looking at all the different types of diets together.

Dan Pardi — 08:44: If we switch back to sodium, what is the estimate for the Paleolithic intake there, and then what is the RDI recommended daily intake?

Lynda Frassetto — 08:53: Recognizing that there's very little sodium chloride in raw foods, and assuming that the Paleo people were eating unprocessed foods, then it would be closer to 6 or 700 milligrams of sodium. So if you say what's a low sodium diet, OK, a low sodium diet would be about. 2000 milligrams of sodium. So the Paleo people were eating 25 % of what we would consider to be a low sodium diet. So extremely low. And if you look at the few remaining hunter gatherers in the world, in fact, their sodium intakes are extremely low.

Lynda Frassetto — 09:36: And if we then look at what are common modern intakes, it can be up to 7000 milligrams in a day. Just look at the back of 1 can of soup exactly so one servings of Campbell Soup is 1000 milligrams. If you have just one serving of soup, you've already had half of your sodium intake on a low sodium diet. And in my experience where we were doing 24 hour urines on people just to kind of see how much sodium they were eating, typically that's 5 to 7000 milligrams of sodium on average. That was the typical people that we were looking at.

Dan Pardi — 10:16: Ok, so there is conversation about lowering sodium in the diet and its benefits on health. But do we actually see health benefits in raising potassium intake as opposed to simply lowering sodium in the diet?

Lynda Frassetto — 10:29: There's two studies that I particularly like when you look at that. So the first one is that DASH sodium diet, they did this really great study where they started out, they looked at 3 levels of sodium intake, 3000 milligrams, 2000 milligrams and 1000 milligrams and then they looked at. Increasing the amount of fruits and vegetables so more potassium inside of each of these three sodium groups, and so they could show that even on the higher sodium diets, just eating more fruits and vegetables lowered blood pressure. So lowering the sodium lowered the blood pressure and eating more fruits and vegetables independently lowered the blood pressure.

Dan Pardi — 11:15: I think people would probably have an easier time raising potassium intake than lowering sodium intake.

Lynda Frassetto — 11:22: Absolutely, positively. I spend a lot of time with my renal failure patients trying to convince them that they should lower their sodium intakes. I have a lot of experience on how difficult it is to try to get people, and these are people who actually have medical reasons for doing this, like how hard it is to get them to do this. You have to make. A conscious decision each and every time you decide to eat something to eat a low sodium diet right it's.

Speaker 1 — 11:53: Like having diabetes. Same idea. Is there any data that you're aware of where there are paradoxes? High sodium diet, but doesn't seem to end up with the complications that you're well aware of in terms of impact on longevity and health.

Lynda Frassetto — 12:11: Now that's a really good question, and I'm going to turn again to the dash data. So when they broke down their data by gender and by race and by whether or not people already had high blood pressure, they could see that you had more of an effect for people who already had high blood pressure than for people who didn't. They had more of an effect for the African Americans who are on the diet compared to the Caucasians. So there appear to be other factors that make a difference in how much of an effect you get from this. So yes, I think that it's a factor. It's not necessarily the only factor. Genetics certainly play the difference as well as. I'm just going to put in a plug here for lifestyle Please do. I don't think that just doing one thing in isolation is necessarily the only answer. It's one of the reasons why I'm interested in the ancestral health movement. Because it looks at things like how much sleep do you get and how much exercise do you do, and how well are you taking care of stress? And on top of what kinds of diets do you eat? Our modern lifestyle is bad for our health and so in order to try to live a healthier lifestyle, you have to do a whole bunch of different things, and diet is one of them.

Lynda Frassetto — 13:39: The fact is, the more we are doing well across other domains, the more we'll be protected in the face of imperfection and other areas right and when it comes to diet, I mean, nobody is going to be able to do this 100 %. I run some studies where we're trying to get people to switch their diet for many months on end. And what we tell people is do the best you can, try to do this most of the time. If sometimes you go out to dinner and, you know, you eat something that's totally wrong, well, OK, so that's just one time. If you can do it most of the time, that's better than not doing it any of the time. So yes, I think that a little touch of reality in here is also very helpful in terms of following diets.

Dan Pardi — 14:28: Do you have any salt replacement tips? How do you add to the flavor of your food without adding more salt?

Lynda Frassetto — 14:37: So with the caveat that with advanced renal failure you have to be very careful about your potassium intake. And most of the things that I do are potassium based supplements. So herbs or lemon juice or garlic. I cook with vegetable juices like V8 or carrot juice and wine instead of oil. Most of the things that I do to try to make things taste more flavorful and not use salt is all related to herbs and things that are high in potassium.

Dan Pardi — 15:12: Let's switch gears here to acid load. Tell us about some of the determinants of a net acid producing diet. What can people do with their diets to minimize diet induced acidosis or the increase in hydrogen ions throughout the body?

Lynda Frassetto — 15:28: So now let's tie the potassium and the sodium to the acid base component of the diet. So yeah, please. The acid part of table salt is the chloride. Sodium is not an acid, but the chloride is definitely an acid. So if you're eating sodium chloride, not only are you getting the sodium load, but you're getting the acid load in the chloride. And similarly if you're eating a high potassium diet, especially if you're getting the potassium from. Fruits and vegetables, the anion in that and these are salts.

Ok, so chloride is a salt and then in table salt, that's the anion in the salt. But in fruits and vegetables, the anions are often alkali, so citrate malate things that are metabolized to bicarbonate. So when you eat a high potassium diet, especially a high fruits and vegetable diet, you're also eating a high alkali intake. So you can see that it now ties in. You eat a lot of table salt, you eat very few fruits and vegetables, You are automatically eating in a high acid. Low based diet?

Then the real question is can your body get rid of the extra acids that you're eating? And if you read the nephrology textbooks for example, they said that yes, absolutely, the functioning kidneys could get rid of all the extra acid and you didn't have any problems whatsoever. If you're young and your kidneys work particularly well, I believe that's true. The problem is that kidney function declines with age. So once you're about two or three and you have all the nephrons in your kidneys, it starts to go down from there. So what that means in terms of how I look at it, once you're starting to be like forty fifty sixty seventy, you've actually lost a fair amount of kidney function.

If you're now eating a high net acid diet all the time, net meaning a lot more acid intake than alkali intake, can your kidneys really get rid of all of that acid? And it's been shown that if you eat a really high acid diet. Although your kidneys can get rid of most of the acid, it can't get rid of all of the acid, and so you end up with an acid balance that's just a little bit higher than it would be if you weren't eating all that extra acid. And when I say a little bit higher, this is still within the range that we consider to be normal, but it's still a higher net acid balance.

I use the word balance, particularly because this means that after all the factors are taken into account and the body has done everything it can do in order to be able to get rid of everything that it doesn't want, you're still ending up with a little bit more acid in your system. And then the question really becomes, So what does this make any difference? This is extremely hard to investigate because what we're talking about. Are these very small differences that occur over decades?

We know that an advanced kidney failure where you absolutely cannot get rid of the acid and now the acid levels are outside of the range of normal. We can show in those people that in fact the acids are naturally making the kidneys deteriorate even faster, are damaging the bones, are causing the muscles to deteriorate. And we extrapolate from that in people who are just eating a high acid dire and who maybe are older, maybe some of the things that we say are due to age, like age-related decline in muscle mass or age-related decline in bone mass. Maybe it's not age that's doing that. Maybe it's the little bit of extra acid that's always been in the system for decades and decades and decades, and could that be a factor in what we're saying is due to getting older?

Dan Pardi — 19:49: Do you have any insights into if a high acid producing diet can accelerate the aging process or does it just become? Particularly problematic as the aging process occurs and we can no longer handle that balance as well as we could before.

Lynda Frassetto — 20:07: Well, this is actually something that we're looking at now because these days we have a little bit more of an insight into some specific factors related to aging like telomere length and klotho levels. Telomeres are at the ends of DNA and there's been studies that show that as you get. Although the number of telomeres decrease and the enzyme that puts more telomeres on goes down, the fewer telomeres you have and the less enzyme you have, the faster the cells age. Similarly, there's this molecule called klotho. In animals that over express klotho, they live longer and you do experiments where you delete the klotho gene, those animals die more rapidly of a disease that looks very similar to aging. So now we have some very specific things that we can look at that we can say, well, does factor X affect kotho or does factor Y affect telomeres? So this is actually something that we're interested in, but do I have any results yet? No, I mean, we're literally doing some studies now.

Dan Pardi — 21:21: Klotho has become an interesting subject in the aging community. Unity Bioscience, which is a biotechnology company focused on the aging process, has made Klotho part of their development program. I know you're looking at this now, but tell us more about what Klotho is.

Lynda Frassetto — 21:38: Klotho is really it's complicated number one. It has more than one forms, so there's one form where it's a membrane bound cofactor for something called FGF 23 which is molecule which is related to phosphate intake and excretion in the kidneys. And so there's a membrane bound form and when the FGF 23 interacts with the membrane bound form of klotho, part of the klotho molecule breaks off floats off to the kidney. Where it affects how proximal tubules in the kidneys reabsorb phosphate. When you eat a high phosphate diet, you make more FGF 23 which goes to the membrane bound Klotho and the FGF 23 receptor. The soluble klotho breaks off, it goes to the kidneys. It prevents the kidneys from reabsorbing the phosphate that you just ate. You dump the phosphate in the urine and you go back into phosphate balance and phosphates are important because that's another type of acid. So inability to excrete phosphorus means that you're maintaining a higher phosphate balance in the body, so therefore also a higher acid balance. Although phosphates have a number of other effects, not the least of which is that they can complex with calcium molecules and. In kidney failure, those calcium phosphate complexes deposit in the blood vessels and the soft tissues and can cause a lot of damage to the tissues. So high phosphate is bad for you with kidney failure in a lot of ways.

Dan Pardi — 23:24: Great answer. Cola, if I'm not mistaken as high in phosphate.

Lynda Frassetto — 23:27: High in phosphate, yes, Phosphaturic acid. It's used as a preservative in all soft drinks that you can't see through, like colas. Again, phosphate is another thing that we limit in kidney failures, one of those things where we have to have a pretty good idea of what to tell our patients what not to eat.

Dan Pardi — 23:47: We also think about salt intake causing high blood pressure. Do we think that it is the acidosis or the chloride? In fact, that is what's causing the higher blood pressure.

Lynda Frassetto — 23:57: My old colleague Curtis Morris has looked at this in some detail. He believes that you have to separate out the potassium, the sodium, the chloride and the alkali and that they're independent factors and that some people are more responsive to sodium and some fatigue, people are more responsive to potassium and some people are more responsive to chloride and some people are more responsive to alkali. And that would make sense if you look at, let's say. Receptors in the kidneys. Because there are specific receptors for all of these things, Any change in the function of a specific receptor would change the ability of the body to respond to that ion. I think that it makes a lot of sense physiologically. That in fact people might be more responsive to one thing or another. In his rat studies he was able to show that in fact it made a difference if you used the chloride ion as opposed to the bicarbonate ion. Now whether that's the effect of the acid, I don't know the answer to that one, but since we believe that the acids are bad for the kidneys. And what we're talking about here is a lot of what's happening inside the kidneys. Yes, possibly there's an acid effect on high blood pressure and kidney function, which is tied to high blood pressure as well as with the potassium and the sodium. And let me just talk a little bit more about kidney failure and high blood pressure. In general, as kidney function declines, your blood pressure goes up. And so this is particularly true once you get to advanced kidney failure where you're only down to about 30 % of kidney function. Because then you have problems getting rid of fluid like water. And because you have more fluid in your system, you have more pressure in your system and therefore the pressure, the blood pressure goes up. I think that all of these things are tied together. But for specific people, might one thing be more important than the other? My guess is yes.

Dan Pardi — 26:15: We do have potential ways to ameliorate that. One possible way is with bicarbonate, which we can take supplementally. There are sodium bicarbonate and there's also potassium bicarbonate. What are your thoughts on that as a supplement?

Lynda Frassetto — 26:30: Sodium bicarbonate is baking set of. If you wanted to take sodium bicarbonate, you could remember that you're taking in a high sodium load, and there are some very specific reasons to think that sodium might be bad for your blood pressure. There's other studies that suggest that you don't have as much of A rise in blood pressure if you take sodium as sodium bicarb compared to sodium as sodium chloride. On the other hand, it doesn't taste particularly good. Potassium bicarbonate, there's a limit to how much you can buy over the counter without a prescription because to the general public, we don't want people to be able to take in large amounts of potassium if they don't know whether or not they have kidney failure or are on some very specific medications. So you're not really allowed to get very much potassium as let's say, a potassium bicarbonate supplement over the counter. Do I actually believe that you should be taking these as supplements? No i think that we do that when we are limited in telling people whether or not to get these things as real food. One, we evolved eating real food and not supplements. And two, you know, when you eat fruits and vegetables, you're eating a high fiber content and there's specific reasons to think that's good for you. There's a lot of trace minerals which are also important, and antioxidants, which we haven't talked about oxidative stress, but it's another kind of stress. Besides acid stress. There's oxidative stress, and that's also bad for you. So I think that the benefits of getting potassium alkali from fruits and vegetables far outweigh actually getting them as a supplement.

Dan Pardi — 28:17: If I'm understanding correctly, you believe that a Paleo style diet is the way to go given your knowledge here on kidney health and acid base balance and sodium potassium balance.

Lynda Frassetto — 28:28: Looked at from an acid base point of view, I think that eating a lot of fruits and vegetables and not a lot of salt is good for you, yes?

Dan Pardi — 28:37: Ok, so then the unknown If you're eating a lot of fruits and vegetables and meats and fish and you're just following a normal Paleo diet. Is there an additional benefit of adding a little bit of potassium bicarbonate to offset the fact that you might have a higher sodium intake and the answer to that is unknown. Did you do some work with mice adding bicarbonate to their water and looking at renal function overtime?

Lynda Frassetto — 29:01: My colleague Curtis Morris did studies where they gave potassium bicarb and potassium chloride and sodium bicarb to rats. And showed that the rats that specifically got the chloride had higher blood pressure, more decline in kidney function, more actual damage to the kidneys when looked at under the microscope, and higher incidence of stroke. If you're saying that this is affecting the blood pressure affects the blood vessels, so can cause damage to the brain and the heart in the kidneys, whether there's also an acid effect in the kidneys, I think that that's probably true and you didn't see as much of an effect, and you gave either the potassium or the sodium as the bicarbonate. There are a lot of reasons why you want to be careful about taking these supplements.

Dan Pardi — 29:56: So having a high amount of potassium intake can be risky, mostly for people that have kidney disease.

Lynda Frassetto — 30:02: People who have kidney disease. People who are on some specific medications. I don't want to make a fuss out of this. I'm a kidney doctor, but I'm sort of against taking supplements as opposed to eating real food. I think that there has to be a specific reason why you have to take it as a supplement as compared to just eating more potassium yeah it's really hard to eat, let's say a huge amount of salad. So for example, in the studies that we did when we were feeding people the Palio diets, when we took the calories from junk food and we turned it into calories from fruits and vegetables, it was so much food like just in terms of how much food there was, that we had to split it into six meals in order to keep their calorie content constant. It's actually really hard to eat a lot of really large amount of fruits and vegetables because it's just so much food.

Dan Pardi — 30:56: One of the reasons I was asking is because several shows ago I spoke with Jeff Rothschild on a review paper that he published last year. In the paper, he reviewed the evidence for some of the best ergogenic or performance enhancing supplements on the market. These were things like beta, alanine, caffeine, creatine and also sodium bicarbonate. Athletes that take sodium bicarb have impressive performance enhancing effect and it's thought to delay acidosis during high intensity efforts.

Lynda Frassetto — 31:28: Some people really do believe in it. There's a guy named Bob Mont who used to coach the British crew team, and he did a lot of experiments about 20 years ago, giving the crew team sodium bicarbonate to see if it improved performance.

Dan Pardi — 31:44: What we think with the bicarbonate is that it really is only effective in exercise that is producing a lot of lactic acid, so it wouldn't be noticeable for lower intensity efforts unless they are very long, like ultra endurance, but mostly for high intensity athletics and probably have a greater effect and less elite athletes.

Lynda Frassetto — 32:05: Right, and there's at least some data in older people that you might improve performance on. Things like sit to stand tests or some strength tests. I don't know the answer to that. Get something that they're looking at now to try to see if it makes a difference. On the other hand, if it prevents muscle breakdown and the more muscle you have, the more exercise you can do, maybe those are tied together too.

Dan Pardi — 32:33: You mentioned the work you're going to be doing on Klotho. Is there other work that you are involved in that relates to these subjects?

Lynda Frassetto — 32:41: The other study that we're running is looking at the effects on polycystic ovarian syndrome because there's some evidence that if you're eating a lower acid diet, you can affect estrogen cyclic activity. That's theoretical, but we are actually looking at that.

Dan Pardi — 33:03: I've never heard of that connection before. That's very interesting. Linda, thank you for joining me. And I've been aware of your work for a long time and I've been looking forward to this conversation that's actionable. And it's also illustrative of the broader idea that we both espouse and believe in, which is that the Paleo diet is a good diet to consider for how you eat in today's world. It aligns more broadly with methodologies for how to live generally in terms of light exposure and sleep, etcetera.

Lynda Frassetto — 33:32: Thanks for inviting me, I really do appreciate the chance to be able to talk about what I do, so thank you very much.

Kendall Kendrick — 33:41: Thanks for listening and come visit us soon at human OS dot me.

Main Topics

The Importance of Sodium and Potassium in the Diet

Low Sodium Diet
Sodium Intake of Hunter Gatherers
Sodium Intake in Contemporary Diet
Potassium Intake in Ancestral Diet
Potassium Intake in Contemporary Diet
Recommended Daily Intake for Potassium

Linda Frasseta's Expertise in Nephrology and Dietary Influences on Acid Base Balance

Regulation of Acid Base Balance in Healthy and Older People
Dietary Influences on Acid Base Balance
Ratios of Potassium to Sodium and Base to Chloride

The Paleo diet and its potential benefits for kidney health and acid balance

The benefits of eating a lot of fruits and vegetables and limiting salt intake
The challenges of consuming large amounts of fruits and vegetables

The Mismatch between Modern Dietary Patterns and Ancestral Nutritional Needs

Refinement of Whole Foods into Purified Ingredients
Shifts in Ratios of Electrolytes
Acid Precursors vs. Base Precursors in the Diet

Performance enhancing supplements and their effects on acidosis

The potential benefits of sodium bicarbonate for high-intensity exercise
The limited effectiveness of bicarbonate for lower intensity efforts

Acid balance and its effects on the body

High acid diet and its impact on aging and age-related decline in muscle and bone mass
Advanced kidney failure and the damaging effects of acids on the kidneys, bones, and muscles

The Link between Chronic Acid Load and Chronic Diseases

Osteoporosis
Hypertension
Cardiovascular Disease
Age-Related Decline in Growth Hormones Accretion

Polycystic ovarian syndrome and its potential connection to acid balance

The theoretical link between a lower acid diet and estrogen cyclic activity
The ongoing study to investigate this connection

Sodium bicarbonate and potassium bicarbonate as supplements

The potential benefits and risks of taking these supplements
The importance of getting nutrients from real food rather than supplements

The Difficulty of Lowering Sodium Intake and the Importance of Lifestyle

DASH Sodium Diet
Difficulty of Lowering Sodium Intake
Importance of Lifestyle in Health

Klotho and its role in the aging process

Klotho as a molecule that affects telomere length and lifespan
The potential impact of factors like diet on Klotho levels

Determinants of a Net Acid Producing Diet

Chloride in Table Salt
Alkali Anions in Fruits and Vegetables
Kidney Function and Age

Tips for Salt Replacement

Herbs, Lemon Juice, Garlic
Vegetable Juices, Wine

Keywords

👩‍⚕️ Polycystic Ovarian Syndrome 💉 Blood Pressure 🍔 Contemporary Diet 💀 Osteoporosis 🧪 Potassium Bicarbonate 🧠 Kidney Function ⚖️ Acid Base Balance 💪 Health 🌾 Grains 🥣 Cereals 🍲 DASH Sodium Diet 👵 Aging 🚑 Chronic Disease 🔬 Nephrology 🧬 Telomere Length 🥩 Paleo Diet ⚠️ Hypertension 🏭 Processed Foods

Questions / Answers

What is Linda Frasseta's background and area of expertise? Linda Frasseta is a professor emeritus of medicine in the Division of Nephrology at the University of California, San Francisco, and her expertise is in the regulation of acid base balance in healthy and older people, as well as dietary influences on acid base balance.
How much sodium and potassium did ancestral people consume compared to modern people? Ancestral people consumed about 25% of what is considered a low sodium diet, while modern people can consume up to 7000 milligrams of sodium in a day. Ancestral people consumed about three times as much potassium as modern people on average.
Do we see health benefits in raising potassium intake as opposed to simply lowering sodium in the diet? Yes, studies have shown that increasing potassium intake, especially in relation to sodium intake, can have significant health benefits, including lowering blood pressure and reducing the risk of cardiovascular disease.
Can a high acid producing diet accelerate the aging process? It is hard to investigate, but advanced kidney failure shows that acids can damage the body and may contribute to age-related decline in muscle and bone mass.
Can a high acid producing diet cause high blood pressure? It is possible, but the effects of sodium, potassium, chloride, and alkali on blood pressure are independent factors that affect people differently.
Are sodium bicarbonate and potassium bicarbonate good supplements to take? There are potential benefits and risks, but getting nutrients from real food is generally better.
Is the Paleo diet a good diet for kidney health and acid balance? Yes, it aligns with the benefits of eating a lot of fruits and vegetables and limiting salt intake.
Can sodium bicarbonate improve athletic performance? It can delay acidosis during high-intensity exercise, but its effectiveness is limited for lower intensity efforts.
Is there a connection between a lower acid diet and polycystic ovarian syndrome? There is theoretical evidence, and an ongoing study is investigating this connection.

Key Points and Insights

Acid balance is important for overall health, and a high acid producing diet can have negative effects on the body, especially in advanced kidney failure.
The Paleo diet aligns with the benefits of eating a lot of fruits and vegetables and limiting salt intake, which can improve kidney health and acid balance.
Sodium bicarbonate can improve athletic performance during high-intensity exercise, but its effectiveness is limited for lower intensity efforts.
Sodium bicarbonate and potassium bicarbonate have potential benefits for acid balance, but getting nutrients from real food is generally better.
There may be a connection between a lower acid diet and polycystic ovarian syndrome, which is being investigated in an ongoing study.
The modern diet is often high in processed foods and grains, which can contribute to chronic acid load and chronic diseases.
Klotho is a molecule that affects telomere length and lifespan, and factors like diet may impact Klotho levels.
Ancestral people consumed much less sodium and more potassium than modern people.
Increasing potassium intake can have significant health benefits.

Quotes

The modern diet is a net acid producing diet, and that's because of the high intake of acid precursors and the low intake of base precursors.

The DASH sodium diet is a diet that's rich in fruits and vegetables, and it's a diet that's low in processed foods and grains.

The best way to replace salt is to use herbs, lemon juice, garlic, and other flavorful ingredients.

The kidneys are very important in regulating acid base balance, and as we get older, our kidney function declines.

The contemporary diet is very different from the ancestral diet, and it's a diet that's high in processed foods and grains.

The modern diet is a diet that's high in acid precursors and low in base precursors, and that's because of the high intake of processed foods and grains.

The modern diet is a diet that's high in sodium and low in potassium, and that's because of the high intake of processed foods and grains.

The contemporary diet is a net acid producing diet, and that's because of the high intake of acid precursors and the low intake of base precursors.

Maybe it's not age that's doing that. Maybe it's the little bit of extra acid that's always been in the system for decades and decades and decades, and could that be a factor in what we're saying is due to getting older?

I'm sort of against taking supplements as opposed to eating real food. I think that there has to be a specific reason why you have to take it as a supplement as compared to just eating more potassium.

Looked at from an acid base point of view, I think that eating a lot of fruits and vegetables and not a lot of salt is good for you.

There's other studies that suggest that you don't have as much of a rise in blood pressure if you take sodium as sodium bicarb compared to sodium as sodium chloride.

The Paleo diet aligns with the benefits of eating a lot of fruits and vegetables and limiting salt intake.

There may be a connection between a lower acid diet and polycystic ovarian syndrome, which is being investigated in an ongoing study.