Metabolic Acidosis

Authored by Chris McDermott, APRN, practicing with autonomous authority in Florida

Introduction

Metabolic acidosis is a condition that results from an imbalance in the body’s acid-base regulation, leading to an increase in systemic acidity. This occurs when the body produces too much acid, fails to excrete enough acid, or loses too much base (bicarbonate). Though often underrecognized in its early stages, persistent acidosis can interfere with cellular metabolism, impair organ function, and contribute to a wide array of chronic conditions.

At Intercoastal Health, we approach metabolic acidosis through a functional medicine practitioner lens, aiming to identify the root cause, correct the underlying imbalance, and restore optimal physiological function using personalized strategies grounded in nutrition, lifestyle, and evidence-based supplementation.

What Is Metabolic Acidosis?

Metabolic acidosis is defined by a reduction in blood pH (typically below 7.35) due to decreased bicarbonate levels or increased acid accumulation. The body normally maintains pH within a tightly regulated range to support enzymatic activity, oxygen delivery, and electrolyte stability. When this balance is disrupted, systemic dysfunction can follow.

Symptoms of Metabolic Acidosis

Symptoms can range from subtle to severe depending on the degree of acidosis, the rate at which it develops, and individual susceptibility. In functional medicine, many of these symptoms are evaluated as potential markers of cellular or systemic acid burden.
Common Clinical Symptoms:

• Fatigue, especially in the early morning
  
• Headaches (occipital to frontal)
  
• Shortness of breath
  
• Anxiety, restlessness, or hyperactivity
  
• Insomnia and nervous system irritability
  
• Digestive disturbances: Diarrhea, bloating, poor nutrient assimilation
  
• High blood pressure or rapid heart rate
  
• Restless legs or muscle cramps
  
• Allergic reactions or skin irritation
  
• Arthritis or chronic inflammation
  
• Dry mouth, bitter taste, or poor salivary flow
  
• Warm, dry hands and feet
  
  

Diagnostic Approach

In clinical practice, metabolic acidosis is evaluated through a combination of laboratory tests and clinical context. Functional practitioners also assess nutrition, toxin exposure, organ health, and lifestyle contributors.

Core Laboratory Markers

Anion Gap Formula: Na⁺ − (Cl⁻ + HCO₃⁻). A high anion gap suggests accumulation of unmeasured acids (e.g., lactic acid, ketones), while a normal anion gap acidosis typically results from bicarbonate loss.

Common Causes of Metabolic Acidosis

Functional medicine recognizes both pathologic and lifestyle-based contributors to metabolic acidosis:

1. Renal Dysfunction — Impaired acid excretion or bicarbonate reabsorption in chronic kidney disease
   
2. Diabetic Ketoacidosis — Excess ketone production lowers blood pH
   
3. Lactic Acidosis — From hypoxia, sepsis, liver dysfunction, or excessive anaerobic metabolism
   
4. Gastrointestinal Bicarbonate Loss — Chronic diarrhea or malabsorption
   
5. Dietary Acid Load — High intake of acid-forming foods (processed meats, refined grains, soda) with low intake of alkaline vegetables
   
6. Poor Cellular Respiration — Due to oxidative stress or mitochondrial damage
   
7. Hypoxia and Stress — Shallow breathing and sympathetic overdrive increase lactic acid
   
8. Toxin Exposure — Methanol, ethylene glycol, salicylate overdose
   
9. Liver Dysfunction — Impaired urea cycle in cirrhosis
   
10. Microbial Overload — Dysbiosis producing acidic byproducts
    
    

Health Risks Associated with Acidosis

Prolonged or uncorrected metabolic acidosis contributes to inflammation, tissue degeneration, and organ dysfunction.

• Chronic Kidney Disease
  
• Hypertension and cardiovascular disease
  
• Diabetes and insulin resistance
  
• Osteopenia and osteoporosis
  
• Cognitive dysfunction and mental fatigue
  
• Muscle wasting and reduced performance
  
  

Medications and Substances That Can Worsen Acidosis

Functional Medicine Treatment at Intercoastal Health

1. Comprehensive Assessment
   
   • History: medications, diet, lifestyle, toxin exposure, underlying disease
     
   • Labs: ABG, anion gap, HCO₃⁻, kidney/liver markers, lactate, ketones
     
   • Physical exam: respiratory rate, hydration, nutrient deficiencies
     
2. Dietary Interventions
   
   • Increase alkaline-forming foods: leafy greens, cruciferous vegetables, citrus fruits, avocados
     
   • Reduce acid-forming foods: processed meats, soda, alcohol, excess coffee
     
   • Ensure adequate hydration
     
3. Supplementation Support
   
   • Magnesium citrate: Buffers acids and supports nerve/muscle function
     
   • Potassium bicarbonate: Alkalizing mineral when potassium is low
     
   • Sodium bicarbonate: Under supervision for select cases
     
   • Glutamine: Supports renal ammoniagenesis and gut health
     
   • B-complex vitamins, CoQ10, alpha-lipoic acid: Enhance mitochondrial function
     
4. Breath & Movement Therapy
   
   • Diaphragmatic breathing to improve oxygenation
     
   • Gentle exercise for lymphatic and acid excretion
     
   • Yoga or breathwork to reduce sympathetic overdrive
     
5. Address Root Causes
   
   • Manage diabetes, kidney, or GI dysfunction
     
   • Support liver detox pathways
     
   • Treat dysbiosis or microbial overgrowth
     
   • Correct nutritional deficiencies
     
     

Monitoring and Follow-Up

• Repeat ABG, HCO₃⁻, anion gap, lactate as indicated
  
• Track symptoms: energy, cognition, digestion, joint health
  
• Adjust diet, supplements, and treatments based on lab trends