LeeAnn,

I posted these questions on an existing thread about acidosis on Dr. Agar's forum; he suggested that I put the question to you as well.

I am at stage 5 CKD and set to begin peritoneal dialysis in a few weeks, and I have been trying to read up on acidosis in renal patients. This was prompted by my nephrologist telling me that I was acidotic. I am taking sodium bicarbonate tablets (2 tablets 3x daily). In addition, my nephrologist also advised me to eat a 2-to-1 balance of alkalizing to acidifying foods until I got on dialysis (as the dialysate is supposed to take care of the acidosis). She provided a list she had printed from a website, listing a number of major foods as either alkalizing or acidifying (the list appears to have originated from the Wolfe Clinic (http://www.thewolfeclinic.com/acidalkfoods.html). Just when I thought I had gotten comfortable with the renal diet, adhering to this list was a new struggle!

My girlfriend tracked down a cookbook in hopes that it would help us make sense of the alkalizing diet (The Amazing Acid Alkaline Cookbook, http://amzn.com/0757003168); the recipes are constructed to have an overall alkalizing effect. The book also provides a chart of foods, noting whether each one is alkalizing or acidifying. The information on these foods appears to be taken from another book, The Acid-Alkaline Food Guide, by Dr. Susan Brown (http://amzn.com/0757002803). Ultimately, however, this cookbook has proved to be more confusing for me than helpful.

Though the lists are generally in agreement (meats, grains, oils are acidifying; many fruits and vegetables are alkalizing), there are still numerous discrepancies between the lists. Looking to the Internet for more information has proved mostly fruitless, as each new list I find contradicts all the others in some way. Further, the vast majority of alkalizing/acidifying food lists I find are on sites propounding what I would consider a naturopathic approach to medicine (which makes me hesitant to trust them at all).

Unsatisfied by my Internet search, I began searching in the academic journal databases subscribed to by the university library where I work. I have located some of the research on treating acidosis in renal patients with sodium bicarbonate. There were also a couple of studies mentioning the use of sodium citrates or potassium citrates as an effective treatment. (My nephrologist was recommending that I drink lemonade to help alkalize me, so now that makes sense.) Try as I might, I could not seem to locate any published research on dietary treatments of acidosis, as my nephrologist has advised. There is one unpublished study mentioned on the DaVita site: a team of researchers at Texas A&M led by Dr. Nimrit Goraya (2010) found that an "alkalizing" diet heavier in fruits and vegetables did slow down kidney injury in patients with kidney disease in early stages. Unfortunately, since I can't read the study, I cannot access their list of which foods were alkalizing. I have been unable to contact Dr. Goraya so far.

So, my questions for you:

Is there a strong research basis that would indicate I should control my acid load through my diet until I get on dialysis? After reading Dr. Agar's explanation of the NaK ATPase pump, I am beginning to question an alkalizing diet even more. That is, if the pump is too busy with hydrogen to keep potassium out of the blood, and many fruits and vegetables can be higher in potassium...you see where I'm going.

Second, if there is a strong research basis for dietary treatment of acidosis, is there any sort of authoritative list of whether foods have an alkalizing or acidifying effect?

Thanks!
Casey