{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T22:05:35Z","timestamp":1779919535818,"version":"3.53.1"},"reference-count":145,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Irma Schutte Foundation","award":["N\/a"],"award-info":[{"award-number":["N\/a"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Evid Based Complementary Altern Med"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:p>When arterial serum pH remains near the lower pH limit of 7.35 for protracted periods of time, a low-grade, sub-clinical form of acidosis results, referred to in this review as chronic, sub-clinical, systemic metabolic acidosis (CSSMA). This narrative review explores the scientific basis for CSSMA, its consequences for health, and potential therapeutic interventions. The major etiology of CSSMA is the shift away from the ancestral, alkaline diet which was rich in fruit and vegetables, toward the contemporary, acidogenic \u2018Westernized\u2019 diet characterized by higher animal protein consumption and lack of base forming minerals. Urine pH is reduced with high dietary acid load and may be a convenient marker of CSSMA. Evidence suggests further that CSSMA negatively influences cortisol levels potentially contributing significantly to the pathophysiology thereof. Both CSSMA and high dietary acid load are associated with the risk and prognosis of various chronic diseases. Clinical trials show that CSSMA can be addressed successfully through alkalizing the diet by increasing fruit and vegetable intake and\/or supplementing with alkaline minerals. This review confirms the existence of a significant body of evidence regarding this low-grade form of acidosis as well as evidence to support its diverse negative implications for health, and concludes that CSSMA is a condition warranting further research.<\/jats:p>","DOI":"10.1177\/2515690x221142352","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T02:17:33Z","timestamp":1669774653000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Chronic Sub-Clinical Systemic Metabolic Acidosis \u2013 A Review with Implications for Clinical Practice"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2167-2872","authenticated-orcid":false,"given":"David Francis","family":"Naude, MTech (Hom)","sequence":"first","affiliation":[{"name":"Irma Schutte Foundation, Drummond, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,11,29]]},"reference":[{"key":"bibr1-2515690X221142352","volume-title":"Human physiology","author":"Fox SI","year":"2004","edition":"8"},{"key":"bibr2-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.3390\/nu9060538"},{"key":"bibr3-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.4102\/phcfm.v7i1.780"},{"key":"bibr4-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2011.03.008"},{"key":"bibr5-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/76.6.1308"},{"key":"bibr6-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/619381"},{"key":"bibr7-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199406233302502"},{"key":"bibr8-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s394-001-8347-4"},{"key":"bibr9-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2891-8-23"},{"key":"bibr10-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00212.2002"},{"key":"bibr11-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006030233"},{"key":"bibr12-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.3390\/nu11061262"},{"key":"bibr13-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/69.4.727"},{"key":"bibr14-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114507862350"},{"key":"bibr15-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/68.3.576"},{"key":"bibr16-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.3390\/nu10040517"},{"key":"bibr17-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/137.6.1491"},{"key":"bibr18-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2012.82"},{"key":"bibr19-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/59.6.1356"},{"key":"bibr20-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.5494\/wjh.v5.i4.129"},{"key":"bibr21-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8223(95)00219-7"},{"key":"bibr22-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1177\/0884533610385702"},{"key":"bibr23-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1002\/mnfr.201600707"},{"key":"bibr24-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980013002115"},{"key":"bibr25-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s00394-013-0496-8"},{"key":"bibr26-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2003.08.020"},{"key":"bibr27-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-145-1-200607040-00004"},{"key":"bibr28-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2019.09.012"},{"key":"bibr29-2515690X221142352","first-page":"1","volume":"49","author":"Steck S","year":"2014","journal-title":"The Digest"},{"key":"bibr30-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/88.4.1159"},{"key":"bibr31-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00128.2003"},{"key":"bibr32-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00136.2010"},{"key":"bibr33-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2016.00222"},{"key":"bibr34-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s001980170095"},{"key":"bibr35-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1080\/07315724.2006.10719536"},{"key":"bibr36-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/79.1.131"},{"key":"bibr37-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.3390\/nu7042499"},{"key":"bibr38-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-003-0091-8"},{"key":"bibr39-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.1764"},{"key":"bibr40-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.87.5.8470"},{"key":"bibr41-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-1350"},{"key":"bibr42-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/87.3.662"},{"key":"bibr43-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-1662"},{"key":"bibr44-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1159\/000186509"},{"key":"bibr45-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/88.2.465"},{"key":"bibr46-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2012.151"},{"key":"bibr47-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-11-88"},{"key":"bibr48-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199809173391207"},{"key":"bibr49-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/51A.1.B91"},{"key":"bibr50-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00587.2010"},{"key":"bibr51-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2018.11.033"},{"key":"bibr52-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/31.2.155"},{"key":"bibr53-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00128-X"},{"key":"bibr54-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.11138\/ccmbm\/2017.14.1.209"},{"key":"bibr55-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2009.02.005"},{"key":"bibr56-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1210\/en.2004-1021"},{"key":"bibr57-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.redox.2013.05.003"},{"key":"bibr58-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-4889(03)00026-0"},{"key":"bibr59-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2006.117382"},{"key":"bibr60-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2799"},{"key":"bibr61-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnutbio.2009.08.002"},{"key":"bibr62-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.113.058255"},{"key":"bibr63-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/86.4.1243"},{"key":"bibr64-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-012-9412-z"},{"key":"bibr65-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.12840"},{"key":"bibr66-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1002\/mnfr.200900099"},{"key":"bibr67-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/83.6.1254"},{"key":"bibr68-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0168906"},{"issue":"4","key":"bibr69-2515690X221142352","first-page":"745","volume":"96","author":"Chen Y-M","year":"2006","journal-title":"British J Nutr"},{"key":"bibr70-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2016.11.006"},{"key":"bibr71-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5002036"},{"key":"bibr72-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5002647"},{"key":"bibr73-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.348"},{"key":"bibr74-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V1291826"},{"key":"bibr75-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1172\/JCI112020"},{"key":"bibr76-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2008111205"},{"key":"bibr77-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.129"},{"key":"bibr78-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.83"},{"key":"bibr79-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.388"},{"key":"bibr80-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.01.017"},{"key":"bibr81-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1159\/000358262"},{"key":"bibr82-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2014040332"},{"key":"bibr83-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1159\/000443746"},{"issue":"3","key":"bibr84-2515690X221142352","first-page":"119","volume":"10","author":"Mirmiran P","year":"2016","journal-title":"Iran J Kidney Dis"},{"issue":"137","key":"bibr85-2515690X221142352","volume":"15","author":"Banerjee T","year":"2014","journal-title":"BMC Nephrol"},{"key":"bibr86-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s00240-005-0001-9"},{"key":"bibr87-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2013.155"},{"key":"bibr88-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s00240-016-0950-1"},{"issue":"10","key":"bibr89-2515690X221142352","first-page":"Cd010057","author":"Phillips R","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"11","key":"bibr90-2515690X221142352","first-page":"1234","volume":"84","author":"Frassetto L","year":"2011","journal-title":"Am Fam Physician"},{"key":"bibr91-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-982517"},{"key":"bibr92-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1111\/imj.1965.14.1.35"},{"issue":"11","key":"bibr93-2515690X221142352","first-page":"2189","volume":"32","author":"Alvarez-Nemegyei J","year":"2005","journal-title":"J Rheumatol"},{"key":"bibr94-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2004.00386.x"},{"issue":"45","key":"bibr95-2515690X221142352","volume":"9","author":"Kanbara A","year":"2010","journal-title":"Nutr J"},{"key":"bibr96-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2891-11-39"},{"key":"bibr97-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1024\/0040-5930.61.9.571"},{"key":"bibr98-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-013-3100-0"},{"key":"bibr99-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.3945\/jn.115.225177"},{"key":"bibr100-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2015.03.008"},{"issue":"12","key":"bibr101-2515690X221142352","volume":"20","author":"Saklayen MG","year":"2018","journal-title":"Curr Hypertens Rep"},{"key":"bibr102-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00670207"},{"key":"bibr103-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0122406"},{"key":"bibr104-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2018.06.005"},{"key":"bibr105-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-02792"},{"key":"bibr106-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2016.02.033"},{"key":"bibr107-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwr049"},{"key":"bibr108-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-010-1371-y"},{"key":"bibr109-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00048.2007"},{"key":"bibr110-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.3945\/jn.114.197020"},{"key":"bibr111-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114508901288"},{"key":"bibr112-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.109.135582"},{"key":"bibr113-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2013.06.028"},{"issue":"4","key":"bibr114-2515690X221142352","first-page":"468","volume":"16","author":"Geborek P","year":"1989","journal-title":"J Rheumatol"},{"key":"bibr115-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1021\/bp060024v"},{"key":"bibr116-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/S0946-672X(01)80064-X"},{"key":"bibr117-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.2174\/1874288200802010100"},{"key":"bibr118-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1097\/MCO.0000000000000171"},{"key":"bibr119-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.04790516"},{"key":"bibr120-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glu215"},{"key":"bibr121-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-012-2203-7"},{"issue":"6","key":"bibr122-2515690X221142352","first-page":"552","volume":"15","author":"Melamed P","journal-title":"Jop"},{"key":"bibr123-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1186\/1550-2783-5-20"},{"key":"bibr124-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s002239900402"},{"key":"bibr125-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1080\/02640410600717816"},{"key":"bibr126-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1123\/ijsnem.15.1.59"},{"key":"bibr127-2515690X221142352","first-page":"141","volume-title":"NSCA's guide to sport and exercise nutrition","author":"Seebohar B","year":"2011"},{"issue":"1","key":"bibr128-2515690X221142352","first-page":"213","volume":"19","author":"Requena B","year":"2005","journal-title":"J Strength Cond Res"},{"key":"bibr129-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1080\/23328940.2018.1436393"},{"issue":"2","key":"bibr130-2515690X221142352","first-page":"271","volume":"18","author":"Hadzic M","year":"2019","journal-title":"J Sports Sci Med"},{"key":"bibr131-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/138.2.426S"},{"key":"bibr132-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(99)70059-4"},{"key":"bibr133-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1111\/j.1439-0442.2004.00677.x"},{"issue":"6","key":"bibr134-2515690X221142352","first-page":"2132","volume":"83","author":"Remer T","year":"1998","journal-title":"J Clin Endocrinol Metab"},{"key":"bibr135-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-0370"},{"key":"bibr136-2515690X221142352","doi-asserted-by":"crossref","DOI":"10.1590\/1414-431x20165577","volume":"50","author":"Cozma S","year":"2017","journal-title":"Brazil J Med Biol Res"},{"key":"bibr137-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1530\/EC-19-0182"},{"key":"bibr138-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2018.12.237"},{"key":"bibr139-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2016.113"},{"key":"bibr140-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.3945\/jn.111.150540"},{"key":"bibr141-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199704173361601"},{"key":"bibr142-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-0217"},{"key":"bibr143-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1089\/089277902753716098"},{"key":"bibr144-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02430312"},{"key":"bibr145-2515690X221142352","doi-asserted-by":"publisher","DOI":"10.1007\/s004210050600"}],"container-title":["Journal of Evidence-Based Integrative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2515690X221142352","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2515690X221142352","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2515690X221142352","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:10:10Z","timestamp":1777389010000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2515690X221142352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":145,"alternative-id":["10.1177\/2515690X221142352"],"URL":"https:\/\/doi.org\/10.1177\/2515690x221142352","relation":{},"ISSN":["2515-690X","2515-690X"],"issn-type":[{"value":"2515-690X","type":"print"},{"value":"2515-690X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]},"article-number":"2515690X221142352"}}