PRAL Score – Acid Load Scoring Facts

PRAL Score is a collection of articles reporting on the scientific use of the PRAL scoring system.

PRAL Score Introduction

I started Foodary with PRAL scoring charts to help me plan and monitor my alkaline diet. As I’ve developed different ways to choose diets and measure their progress, I’ve realized that all that data can be overwhelming. So I’m moving PRAL scores to a new website. Allowing me to focus on explaining the principles of PRAL scores here on Foodary.

Also, I add practical examples of those PRAL scoring principles. By describing the way scientists use PRAL scores to measure the effects of alkaline diet on wellbeing and diseases.

What is PRAL Score?

PRAL score is a calculation that estimates the acid load on kidneys after digesting foods. Usually you calculate a daily PRAL score based on all the food and drink that you consume in one day. Or you might analyze your weekly food intake and divide by 7 to get a daily score. Your professional adviser will tell you what period is best for you. Also, they might advise you how to estimate the pH of your urine from your PRAL score. So that you can compare potential acid load with your actual urine pH.

Note that positive PRAL values indicate food that is acid-forming. Whereas negative PRAL values indicate food that is alkalizing. Some doctors advise you to collate total acid PRAL scores and total alkaline PRAL scores. Then you can add those to get a total net PRAL score. In this way, your adviser can assess the balance between acid-forming and alkalizing food intake.

PRAL Score List

I’m preparing an index for existing PRAL score articles. Then I will list them here. In the meantime, here’s a list of PRAL scoring science reports I will add. So if you want to know when I publish them, please…

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PRAL Score and Breast Cancer
Park YM, Steck SE, Fung TT, Merchant AT, Elizabeth Hodgson M, Keller JA, Sandler DP. Higher diet-dependent acid load is associated with risk of breast cancer: Findings from the sister study. Int J Cancer. 2019 Apr 15;144(8):1834-1843. Epub 2018 Dec 7. PMID: 30247761; PMCID: PMC6394228.

Since PRAL scores are positively correlated with meat consumption and negatively correlated with fruit and vegetable intake, results also suggest that diets high in fruits and vegetables and low in meat may be protective against hormone receptor negative breast cancer.

Wu T, Hsu FC, Wang S, Luong D, Pierce JP. Hemoglobin A1c Levels Modify Associations between Dietary Acid Load and Breast Cancer Recurrence. Nutrients. 2020 Feb 23;12(2):578. PMID: 32102184; PMCID: PMC7071352.

dietary acid load [positive PRAL score] was associated with increased risk of breast cancer recurrence among breast cancer survivors.
Impacts: Our study provides strong evidence for developing specific dietary acid load guidelines based on HbA1c levels.

PRAL Score and Diabetes
Gæde J, Nielsen T, Madsen ML, Toft U, Jørgensen T, Overvad K, Tjønneland A, Hansen T, Allin KH, Pedersen O. Population-based studies of relationships between dietary acidity load, insulin resistance and incident diabetes in Danes. Nutr J. 2018 Oct 6;17(1):91. PMID: 30292239; PMCID: PMC6173920.

the acidity of the diet may be related to increased risk of type 2 diabetes. To investigate this hypothesis, we tested if the acidity of the diet, measured as the Potential Renal Acid Load (PRAL) score, was associated with incident diabetes and diabetes-related intermediary traits. […] The increased risk of diabetes may be related to our finding that a high dietary acidity load associates with impaired insulin sensitivity.

Akter S, Kurotani K, Kashino I, Goto A, Mizoue T, Noda M, Sawada N, Tsugane S; Japan Public Health Center–based Prospective Study Group. High Dietary Acid Load Score Is Associated with Increased Risk of Type 2 Diabetes in Japanese Men: The Japan Public Health Center-based Prospective Study. J Nutr. 2016 May;146(5):1076-83. Epub 2016 Apr 6. PMID: 27052540.

A high dietary acid load [PRAL] score is associated with an increased risk of type 2 diabetes

PRAL Score and Death
Akter S, Nanri A, Mizoue T, Noda M, Sawada N, Sasazuki S, Tsugane S; Japan Public Health Center–based Prospective Study Group. Dietary acid load and mortality among Japanese men and women: the Japan Public Health Center-based Prospective Study. Am J Clin Nutr. 2017 Jul;106(1):146-154. Epub 2017 May 24. PMID: 28539378.

There was no association between PRAL score and cancer mortality. […] A high dietary acid load score was associated with a higher risk of total mortality and mortality from cardiovascular disease, particularly from ischemic heart disease

PRAL Score and Cardiovascular Disease
Han E, Kim G, Hong N, Lee YH, Kim DW, Shin HJ, Lee BW, Kang ES, Lee IK, Cha BS. Association between dietary acid load and the risk of cardiovascular disease: nationwide surveys (KNHANES 2008-2011). Cardiovasc Diabetol. 2016 Aug 26;15(1):122. PMID: 27565571; PMCID: PMC5002186.

The association between higher PRAL score and high CVD risk was stronger in the middle-aged group. […] individuals in unhealthy condition with lower PRAL scores had comparable ASCVD [atherosclerotic cardiovascular disease] risk to people in the higher PRAL group that were in favorable physical condition. In addition, elevated PRAL scores were associated with high ASCVD risk independent of obesity, exercise, and insulin resistance, but not sarcopenia [age related, involuntary loss of skeletal muscle mass and strength].

Foodary Acid Alkaline PRAL Score

Is Your PRAL Score On Target?

Your PRAL Score

You assess your personal PRAL score by adding up the individual PRAL values for all the food and drink you consume in one day. But your PRAL score has little meaning if you don’t know your target.

So consult your doctor, dietitian, or other appropriate health professional about your daily PRAL target. Then compare it with your total PRAL score each day. Or measure the PRAL score of your weekly grocery bills and divide by 7 for your average daily score.

Please tell me about your PRAL score using the feedback form below. Do you measure PRAL score daily or weekly? How does it compare to your target?

Leave PRAL Score – Acid Load Scoring Facts to read PRAL Potential Renal Acid Load.

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