Balancing the Body's pH: What You Need to Know About Metabolic Acidosis

The body needs acids to survive. They help digest food, absorb nutrients, and produce energy. But what happens if there is too much acid in the body? Learn more about metabolic acidosis and hear from a patient who experienced it firsthand.

A healthy body maintains a balanced pH. The pH scale measures how acidic, neutral, or alkaline something is. It ranges from 0 (acidic) to 14 (basic). Too much acid (being acidic) or too many bases (being alkaline) can cause or be caused by health problems. 

A pH level between 7.35 and 7.45 is considered balanced for most people.

There are several ways the body balances its pH levels:

• Blood: Contains buffers like bicarbonate and hemoglobin, which help neutralize extra acids.
• Lungs: Regulates carbon dioxide levels to help maintain blood pH.
• Kidneys: Filters out excess acids and help maintain the right amount of bases in the blood.

Learn more about how the kidneys function. 

Metabolic acidosis occurs when there is too much acid in the body. This condition often affects people with kidney disease since the kidneys help balance the body's pH by removing excess acids.

Other metabolic acidosis risk factors include:

• Acute kidney injury: Sudden loss of kidney function
• Hyperkalemia: High potassium levels
• Albuminuria: Excess protein in urine
• Smoking: May increase blood pressure or damage kidneys
• Anemia: Low red blood cell levels
• Diabetes-related ketoacidosis: Lack of insulin that causes sugar levels to increase and create acids
• Lactic acidosis: Increase of lactic acid, which many conditions like cancer, liver failure, heart failure, and severe asthma can cause.

Severe diarrhea, dehydration, or antifreeze poisoning may also increase someone's risk of developing this condition. 

Learn more about the causes of metabolic acidosis.

Symptoms vary from person to person and may be difficult to spot. 

These may include:

• Fast, deep breathing in the early stages
• More difficulty breathing in the late stages
• Racing heart
• Confusion
• Exhaustion
• Weakness
• Nausea, vomiting, or loss of appetite

Healthcare practitioners diagnose metabolic acidosis by checking kidney function, blood, and urine. 

• eGFR: Tests the blood for levels of creatinine, a waste product. High levels of creatinine can point to kidney issues.
• Comprehensive metabolic panel (CMP): A blood test examining chemical balance and metabolism. For metabolic acidosis, practitioners look for bicarbonate, a base. Low levels of bicarbonate suggest that there may be too much acid in the body.
• Urinalysis: A urine sample may be taken to determine how much acid is in it.

If metabolic acidosis isn't managed, people may experience weakening bones and muscles, worsening kidney disease, or even death. 

Learn more about metabolic acidosis symptoms.

First, healthcare practitioners need to treat the underlying cause. For example, someone with kidney failure would start dialysis treatment to help remove excess acids from the blood. A person with diabetes-related ketoacidosis would work with their doctor to raise their insulin levels. 

It's also important to eat a low-acidic diet. Fruits, vegetables, and plant-based proteins produce alkali, a base that helps balance out the acid. Meat, egg yolks, cheeses, and grains may increase acid levels. 

Working with a healthcare practitioner is key because overeating the wrong fruits and vegetables can worsen some conditions, like hyperkalemia or high potassium.

"Prevention and treatment of metabolic syndrome requires changes in lifestyle," said kidney dietitian Janelle E. Gonyea. "Changing habits can be difficult. Talk to your healthcare provider or find a kidney dietitian for help."

If diet changes aren't enough, a healthcare professional may also prescribe medications that increase the amount of base in the blood.

Learn more about metabolic acidosis treatments.

While everyone's experience of metabolic acidosis differs, Jessica highlights how kidney damage can disrupt the body's pH level. 

In 2018, Jessica became extremely ill. After six months and frequent trips to the emergency room, she was diagnosed with lupus and lupus nephritis. Lupus is an autoimmune disorder that occurs when the immune system attacks its own body. Lupus nephritis occurs when the immune system targets and damages the kidneys. 

While searching for medications that worked, Jessica expected lupus flare-ups. That's why she didn't notice the first symptoms of metabolic acidosis–exhaustion and weakness.

"Flare ups occurred while I was stressed or eating highly acidic foods," Jessica said. "I couldn't do simple things like cook or open jars. I couldn't drive."

As time passed, Jessica's symptoms got worse. She went to the hospital to find out why. 

"I learned I had acute kidney failure from lupus nephritis. I also had metabolic acidosis because my kidneys weren't filtering excess acid out," Jessica said. "This explained why my symptoms got worse after eating acidic foods like meat."

Jessica spent the next two months in the hospital recovering from acute kidney failure and metabolic acidosis. 

"I got better by eating more plant-based foods, taking medication properly, and following my water restrictions," Jessica said. "I was discharged and stopped dialysis but continued to follow a low-acidity diet, exercising, and taking medications as directed by doctors."

Learn more about Jessica's story.