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Articles in PresS, published online ahead of print September 24, 2002
Am J Physiol Renal Physiol, 10.1152/ajprenal.00212.2002
Submitted on June 5, 2002
Accepted on August 8, 2002
1 Medizinische Universitatsklinik und Zentrallabor, Kantonsspital Bruderholz, Bruderholz/Basle, Basel, Switzerland
2 Institut fur Chemie und Hamatologie, Kantonsspital St.Gallen, St.Gallen, St.Gallen, Switzerland
3 Genentech Inc, Roche Pharm Inc, South San Francisco, CA, USA
* To whom correspondence should be addressed. E-mail: reto.krapf{at}ksbh.ch.
Background: A western type diet is associated with osteoporosis and calcium nephrolithiasis. Based on observations that calcium retention and inhibition of bone resporption result from alkali administration, it is assumed that the acid load inherent to this diet, is responsible for increased bone resorption and calcium loss from bone. It is not known, however, whether the dietary acid load acts directly or indirectly (i.e. via endocrine changes) on bone metabolism. It is also unclear, whether alkali administration affects bone resorption/calcium balance directly or whether alkali-induced calcium retention is dependent on the cation (i.e., potassium) supplied with administered base. Methods: The effects of neutralization of dietary acid load (equimolar amounts of NaHCO3 and KHCO3 substituted for NaCl and KCl) in 9 healthy subjects [6 men, 3 women] under metabolic balance conditions) on calcium balance, bone markers and on endocrine systems relevant to bone (glucocorticoid secretion, IGF-1, PTH/1,25(OH)2 Vitamin D and thyroid hormones) were studied. Results: Neutralization for 7 days induced a significant cumulative calcium retention (10.7±0.4 mmols) and significantly reduced the urinary excretion of deoxypyridinoline, pyridinoline and n-telopeptide. Mean daily plasma cortisol decreased from 264 ± 45 to 232 ± 43 nmol/l (p = 0.032) and urinary excretion of tetrahydrocortisol (THF) decreased from 2410 ± 210 to 2098 ± 190 ug/24h (p = 0.027). No significant effect was found on free IGF-1, PTH/1,25(OH)2Vitamin D or on thyroid hormones. Conclusions: An acidogenic Western diet results in mild metabolic acidosis in association with a state of cortisol excess, altered divalent ion metabolism and increased bone resorptive indices. Acidosis-induced increases in cortisol secretion and plasma concentration may play a role in mild acidosis-induced alterations in bone metabolism and possibly in osteoporosis associated with the acidogenic Western diet.
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