Dr. Susan Brown, and The Osteoporosis Education Project, consider the link between bone health and systemic acid/alkaline balance to be one of critical importance. In fact, it is our opinion that chronic low-grade metabolic acidosis is the major "hidden" cause of osteoporosis. In Dr. Brown's book, Better Bones, Better Body and in her article with Dr. Jaffe,  Acid-Alkaline Balance and Its Effect on Bone Health, she explores in full the relationship between bone and systemic pH (acid/alkaline balance).

An important research priority of Dr. Susan Brown and her non-profit organization, The Osteoporosis Education Project, is to conduct original research on pH balance and bone. Below we discuss our research on this topic to date. Our first piece of research focuses on the value of first-morning urine pH measurements and is entitled, "First-Morning Urine pH Correlation with Acid Load." The second study documents the value of metabolic alkaline supplements for those suffering from interstitial cystitis. This study was entitled, "Interstitial Cystitis and pH Balance".

Dr. Susan Brown and the Osteoporosis Education Project actively solicit collaboration and exchange with other like minded individuals and organizations concerned with the practical health implications of chronic low grade metabolic acidosis.

First-Morning Urine pH Correlation with Acid Load

The Osteoporosis Education Project has conducted several research projects on acid-alkaline balance. One project was collaborative research with Dr. Susan Whiting of the University of Saskatchewan on the relationship between first-morning urine pH measurement and net acid load. An abstract of these research findings as presented at the 2002 ASBMR meeting follows. Investigators were Susan Whiting, Ph.D., Janet Bell, and Susan E. Brown, Ph.D., CNS.

First-Morning Urine Measured with pH Paper Strips Reflects Acid Excretion

Susan J. Whiting and  Janet Bell, College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Saskatoon, SK, S7N 5C9, and Susan E. Brown, The Osteoporosis Education Project, 605 Franklin Park Drive, East Syracuse, NY 13057

Net acid excretion (NAE) is implicated in bone loss, as increased calcium loss is seen with a high net acid excretion. Dietary protein is identified as a significant producer of acid whereas fruits and vegetables may counteract this effect through the production of metabolizable organic anions, which buffer acid. Determination of NAE is important in recognizing the effect diet may have on bone. Most commonly, a 24-hour urine collection is obtained for measurement of NAE where NAE is measured as titratable acidity minus bicarbonate (TA-bicarb) plus ammonium (NH4+). However, this measurement can be inconvenient and pH measured on first-morning urine with semi-quantitative paper strips may be a practical estimator of NAE. We recruited 23 (4M, 19F) healthy subjects aged 20-50 yrs who recorded dietary intake for a day during which they collected urine from approximately 7 am to 11 pm in one container ("day") and approximately 11 pm to 7 am ("overnight",ON) in a separate container. The first-morning void contained ON urine. Subjects also provided a two-hour fasting urine at 9 am. pH paper strips (colorpHast ®, EM-Reagents, range 4-7) were used to measure pH of the ON urine, as would be done in practice. A second set of strips (pH range 6.5-10) was used if the initial pH read high. Although measurement with pH paper strips was not significantly correlated with 24-hr NAE, there was a significant correlation with 24-hour TA-bicarb (r= -0.466, p<0.025). Further, pH strip measures were significantly correlated with ON NAE (r= -0.710, p<0.005). We noted that ON NAE was correlated with total NAE (r=0.504, p<0.014). We conclude there is useful information in measuring first-morning urine pH (which provides pH of urine formed overnight) to obtain an estimate of acid excretion. pH paper strips appear to be useful in the absence of longer (more invasive) urine collections.

The Osteoporosis Education Project has compiled other important acid alkaline balance abstracts from the 2002 ASBMR conference.

Interstitial Cystitis and Metabolic Acidosis

Chronic low-grade metabolic acidosis is known to aggravate the kidney and bladder and worsens all forms of cystitis. Conversely reducing urinary acid load should bring a degree of symptom relief. In the winter of 2003, we analyzed data from an intervention study using alkalizing salts in the treatment of pain and urgency from interstitial cystitis. The study used Tamer® Products to alkalize. The symptom relief was very impressive. For full study results, please see Excessive Acidity May Aggravate Urinary Disorders - A Case Study - A Novel Therapy For Interstitial Cystitis.