Vol. 7, Issue 1, Part A (2025)

Dietary acid load (DAL), primarily influenced by the intake of acid and base forming foods, has emerged as a significant dietary factor impacting metabolic health. This review provides a comprehensive analysis of the role of DAL in overall health, with a particular focus on its relationship with different types of diabetes, including type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes mellitus (GDM). In this review we explore the physiological mechanisms through which a high acid-forming diet may contribute to insulin resistance, impaired β-cell function, systemic inflammation, and altered renal function key factors in the pathogenesis of diabetes. We also examine the associations reported in epidemiological and clinical studies, highlighting inconsistencies, potential confounders, and the need for standardized assessment methods such as net endogenous acid production (NEAP) and potential renal acid load (PRAL). Additionally, we discuss the implications of dietary patterns, including western diets and plant-based diets, on DAL and metabolic outcomes. Understanding the impact of DAL offers a promising avenue for dietary interventions aimed at diabetes prevention and management. Future research directions are proposed to further elucidate causal relationships and guide nutritional recommendations.