Don’t read this if you are dabbler with your baby toe half way immersed in a warm bath tub.

Only read this if you are willing to dive in and swim out to the middle of lake with no knowledge of how far it is or if you will have the energy to get home. Because this post may leave that cozy little place you cling to up in flames. I know it did for me. But you will build it back on the other side stronger and more resilient than before, and then guess what, it’s time once again to dive back into that cold beautiful unknown.

Here we go…

“If you accumulate acid in your body it will inhibit every single function, and you will die.”

-Dr. Bob Rakowski

I first got really interested in pH when I dove deep down the rabbit hole of PRI and OmegaWave. This was a little over two years ago, and it was a result of the data pushing us there. Coach Davis and I ran an annoying amount (like 300+) of long OmegaWave readings on athletes and general population clients. Almost everyone came back in a hyperventilated state. They also nearly always came back in a state of excessive extension. They were living on the top part of their lungs with dirty anterior pelvic tilts. If you have rummaged around in PRI circles, you will know that the right answer is always breathing.

But I questioned this chicken and egg philosophy. And even with the commonalty of sympathetic dominance and underlying autonomic dysregulation, I pondered… could there be another intervening or mediating variable?

An intervening variable can be explained best with examples. The amount of murders and the amount of churches are positively related to each other. This is a fact. As the number of churches in a city increases, so does the murder rate. What!? This doesn’t make any sense!

How about this one? The number of firefighters at a fire is positively related to the damage of the fire. Wait…what? If you infer causation – this would mean that firefighters are causing fire damage and churches are murdering people. Enter the intervening variable, and the danger of inferring causation from cross-sectional data.


The intervening variable for the churches and murders is population growth. As the population rises, you get more churches, but you also get more murders, therefore they track together. And as the intensity of the fire increases, more firefighters come, and there is more resultant damage from the fire.

So in the PRI world, we have this cross-sectional finding of hyperventilation and excessive extension. We have a mediating variable of dysregulated autonomics that is likely resulting in dysregulated breathing, and thus the vicious loop of excessive extension. But maybe there is more to the story. Remember my PhD is in Nutrition Sciences, and I practice Functional Medicine, thus I have to figure out ways to make that apply to everything. 🙂

None of my clients or patients had emphysema or chronic bronchitis, so a primary respiratory acidosis was unlikely, but many were coming back with functional metabolic acidosis on blood work, and most had horrific salivary pH challenge scores. Thus I had to start asking bigger, more fundamental questions because the respiratory compensation for metabolic acidosis will be hyperventilation as a way to get rid of acid. This is because blood pH is very tightly regulated between a slightly alkaline pH of 7.35 and 7.45.

This regulation falls under the duty of the lungs, kidneys, and a series of intracellular and extracellular buffers. Every enzyme and every hormone in the human body is pH dependent, and every energy dependent process in the human body produces acid as a byproduct. In fact, the human body makes 15,000 mmol of acid a day, and if we don’t get rid of it every minute, we die. Don’t believe me, let’s all just stop exhaling for a few minutes…



Now, to really jump down the nerd chute. When we start oxidizing carbon for energy, we get CO2, and as you know, CO2 combines with water to make carbonic acid, which disassociates into H+ and Bicarb. But the body doesn’t want the blood to get too acidic so it starts compensating and hyperventilating to dissipate CO2, and it also pushes H+ back into cells in exchange for a positive ion (usually Potassium or Magnesium). In this state, the blood actually becomes more alkaline. In turn, when the blood is more alkaline, hemoglobin will not give up oxygen as easily. This is known as the Bohr effect. So as you become more acidic, you deprive tissues of oxygen (even more hyperventilation) and progressively deplete minerals (eating up your buffering capacity). Then once the cell is chock-full of Hydrogen ions, it will start spilling acid into the blood, and the blood pH lowers. Things just got real, and your body is going to bring out all the guns to buffer that acid – hyperventilation, increased kidney excretion, all the minerals, glutamine, and albumin, and you will even start leaching calcium from bones to neutralize the assault of acidity.

So maybe all these acidotic, mouth breathing, alligators are the result of the dis-layering of basic metabolic processes, and we have a ton of intervening variables.

That was deep. Let’s take another exhale and go grab a bowl of organic Swiss Chard.

I’ll wait…

Enter all the things that increase your risk for metabolic acidosis:

Excessive exercise – #CrossFit

Lack of exercise – #Merica

Stress – #Life

Liver dysfunction and alcohol intake – #College

Poor Diet – #ImLovinIt

Poor Digestion – #Tumtatumtums

Inefficient ATP production or increased reliance on anaerobic respiration (AKA mitochondrial toxicity and fatigue) – #IJustCantAdultRightNow

How many of your patients suffer from one or all of the above hashtags? Ummm…. pretty much all of them, as only 2.7% of Americans were non-smokers who accumulated sufficient physical activity, had a healthy eating index above the 60th percentile (cough – bullsh@t), and a normal body fat percentage (Loprinzi et al).

Now, do you see why your Modified All Four Belly Lift may just be a weird band-aid for global physiologic and autonomic dysfunction?

Mod All 4 Belly Lift

“pH imbalances always involve respiratory function, either as the cause or as a compensatory mechanism.”

-Dr. Dicken Weatherby

Sometimes people need band-aids. I love the Modified All Four Belly Lift, and I think addressing proper breathing and autonomics is a pillar of health, but I also believe in things like micronutrients, vegetables, and water.

There is a concept called The Healthy and Unhealthy User Bias which states that healthy and unhealthy behaviors tend to cluster together. For instance, red meat intake, fast food consumption, alcohol intake, and sedentary behavior are all related cross-sectionally. So if you chose any one of the those independent variables you need to account for the others in your statistical analysis and this bias is how red meat got dogged for so long. I don’t think the answer to our current hyperventilation conundrum is a 17 arm cross-0ver randomized controlled trial (RCT). I believe it is all of us looking outside our scope of practice and asking if there is something we don’t know we don’t know. Then we need to put it in play and assess if it makes what we do more effective. We ask hard questions. We work together to identify our blind spots. And then we test and report back on what we find. This is science, more specifically you will be running what are called effectiveness trials and your patients need it more than anything else. Put your lab coat on and let’s roll.



Everyone should buy Dr. Rakowski’s Bio Terrain and In-Office Diagnostics lectures. Talk about down the rabbit hole.

Acid Base Balance – Dr. Dicken Weatherby

Functional Medicine University – Discussion Forum

Loprinzi PD, Branscum A, Hanks J, Smit E. Healthy Lifestyle Characteristics and Their Joint Association With Cardiovascular Disease Biomarkers in US Adults. Mayo Clinic proceedings. Feb 20 2016.


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