{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T23:44:02Z","timestamp":1790034242470,"version":"4.0.1"},"reference-count":101,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T00:00:00Z","timestamp":1708041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Diets can influence the body\u2019s acid\u2013base status because specific food components yield acids, bases, or neither when metabolized. Animal-sourced foods yield acids and plant-sourced food, particularly fruits and vegetables, generally yield bases when metabolized. Modern diets proportionately contain more animal-sourced than plant-sourced foods, are, thereby, generally net acid-producing, and so constitute an ongoing acid challenge. Acid accumulation severe enough to reduce serum bicarbonate concentration, i.e., manifesting as chronic metabolic acidosis, the most extreme end of the continuum of \u201cacid stress\u201d, harms bones and muscles and appears to enhance the progression of chronic kidney disease (CKD). Progressive acid accumulation that does not achieve the threshold amount necessary to cause chronic metabolic acidosis also appears to have deleterious effects. Specifically, identifiable acid retention without reduced serum bicarbonate concentration, which, in this review, we will call \u201ccovert acidosis\u201d, appears to cause kidney injury and exacerbate CKD progression. Furthermore, the chronic engagement of mechanisms to mitigate the ongoing acid challenge of modern diets also appears to threaten health, including kidney health. This review describes the full continuum of \u201cacid stress\u201d to which modern diets contribute and the mechanisms by which acid stress challenges health. Ongoing research will develop clinically useful tools to identify stages of acid stress earlier than metabolic acidosis and determine if dietary acid reduction lowers or eliminates the threats to health that these diets appear to cause.<\/jats:p>","DOI":"10.3390\/ijms25042336","type":"journal-article","created":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T06:00:25Z","timestamp":1708063225000},"page":"2336","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Pathophysiology of Diet-Induced Acid Stress"],"prefix":"10.3390","volume":"25","author":[{"given":"Nimrit","family":"Goraya","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Baylor Scott & White Health, Temple, TX 76508, USA"},{"name":"Department of Internal Medicine, Texas A&M Health Science Center College of Medicine, Temple, TX 76508, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald E.","family":"Wesson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Dallas, TX 78712, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Gropper, S.S. 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