The physiological pH of the human body is essential for the numerous processes necessary for life. pH varies in distinct parts of the body. Our kidneys are responsible for the chronic regulation of acid-base disorders. Metabolic acidosis is a condition characterized by an excess of acid in the body due to the accumulation of acid or loss of bicarbonate. It is diagnosed when the blood pH drops below 7.35. However, chronic metabolic acidosis can be silent and maintain a normal pH by drawing from various buffering systems in the body. It can remain asymptomatic for years. Certain symptoms include:

• Nausea
• Fatigue
• Confusion
• Shortness of breath
• Muscle loss/atrophy
• Insulin resistance
• Non-alcoholic fatty liver disease
• Osteoporosis
• Sarcopenia
• Kidney stones
• Hypertension
• Stroke
• Renal insufficiency
• Kidney failure

Exploring Root Causes

• The Standard American Diet (SAD)
• Mouth breathing, poor breathing
• Stressed kidneys
• Insulin resistance, diabetes
• Smoking
• Hypertension
• Infections, stealth pathogens

Evaluating Metabolic Acidosis

1. Calculate your PRAL score. If the score is higher than 25, it indicates metabolic acidosis. See how to calculate below.

2. Test Serum CO2 (Bicarbonate). If serum CO2 is lower than 25, it indicates low-grade chronic metabolic acidosis. Serum CO2 is not reflective of serum pH If you have respiratory issues such as asthma, emphysema, COPD, pneumonia, etc.

3. Test Urinary pH levels with 24-Hour Urine Analysis.

DIETARY CHANGES & SUPPLEMENTS

1. INCREASE:

• Potassium intake from foods & supplements (4700 mg/day)
  • Foods:
    
    • Salmon
    • Baked potato (with skin)
    • Cod
    • Avocado
    • Sweet potato
    • Pork chop
    • Brussels sprouts
    • Bananas
    • Dairy, yogurt
    • White beans
    • Spinach
    • Orange juice (not recommended if struggling with insulin resistance)
    • Dried apricots (not recommended if struggling with insulin resistance)
    • Dates (not recommended if struggling with insulin resistance)
  • E-Lyte by BodyBio: 2-3 capfuls a day, in divided doses in liquid. If it is sold out on Fullscript: E-lyte by BodyBio (Code: PAOLA)
  • Optimal Electrolytes Seltzer by Seeking Health: 1 scoop a day , in liquid , not close to bedtime
  • Adrenal Cocktail by Jigsaw: 1-2 scoops a day, in divided doses, in liquid
• Magnesium intake from food & supplements (400-800mg/day)
  • Foods
    • Pumpkin seeds
    • Almonds
    • Spinach, boiled
    • Cashews
  • Magnesium Breakthrough by Bioptimizer (discount code PAOLA): 1-3 capsules per day, in divided doses, with meals
  • Morning Magnesium by Smidge: 4 capsules with breakfast. If it is sold out on Fullscript: Smidge (discount code PAOLA)
  • Evening Magnesium By Smidge: 2 capsules with dinner. If it is sold out on Fullscript: Smidge (discount code PAOLA)
• Calcium intake from foods
  • Sardines, canned in oil, with bones
  • Cheddar cheese, shredded
  • Milk, nonfat
  • Yogurt
  • Milk
  • Milk, buttermilk
  • Cottage cheese
  • Mozzarella

2. REDUCE

• Reduce phosphorus intake by reducing the consumption of processed foods.
• Adjust protein intake if you are consuming excessive amounts of protein. Calculate how much protein you need using the provided resource.

Note: Select one potassium supplement and one magnesium supplement. Strive to restore your mineral levels through dietary sources. Follow these dietary adjustments for a minimum of 30 days and reassess your PRAL score and serum CO2 levels. If there is no improvement in your PRAL score or serum CO2, contemplate the other underlying causes discussed in this protocol.

Instructions: 

• Supplements can be found on Fullscript. Save 20% on all supplements when signing up for Fullscript here.

HOW TO CALCULATE YOUR PRAL SCORE

1. STEP 1: USE THE CRONOMETER APP
   1. Find out how much protein (in grams), phosphorus (in mg), potassium (in mg), calcium (in mg), magnesium (in mg), you are consuming per day
2. STEP 2:
   1. Calculate your PRAL score

      (PRAL in mEq/day) = (0.49 × protein intake in g/day) + (0.037 × phosphorus-intake in mg/day) - (0.02 × potassium intake in mg/day) - (0.013 × calcium intake in mg/day) - (0.027 × magnesium intake in mg/day) - Reference for this formula

3. STEP 3:

   1. Determine what your score means
      1. If PRAL < 0: Continue with your diet and consider other root causes for your symptoms. 
      2. If PRAL 0-25: 
         1. Increase the intake of foods rich in potassium, magnesium and calcium. 
         2. Consider the PRAL diet. 1/3 of your plate can be foods from the orange list, and 2/3 of your plate can be foods from the green list.
         3. Re-evaluate in 7 days.  
         4. If your PRAL continues to be 0-25, consider adding more foods that are rich in potassium, magnesium and calcium. Consider adding more foods from the green list. 
      3. If PRAL >25: Check Serum CO2. If CO2 <25 consider low-grade metabolic acidosis. Increase the intake of foods rich in potassium, magnesium and calcium. Decrease the intake of foods rich in phosphorus and protein if you are overeating protein. Re-evaluate in 30 days. 
         1. If your symptoms and score improve, continue with the same diet.
         2. If your symptoms and score do not improve, continue with the same diet and also consider other root causes.