New Study on Dietary Acidity and Its Effect on Fertility
How Dietary Acid Load Affects Ovarian Reserve: A Deep Dive into the Latest Research
Since I started doing this in 2004, I have been asked thousands of times if acidity is linked to fertility. While there have been studies that have touched upon this in the past ten years (here, and here), and we know that diet-induced acidosis (DIA) is responsible for an increased risk of many health conditions from type 2 diabetes to cardiovascular disease, there hasn’t been a study this specifically looking into DIA and fertility.
It’s a fantastic step forward.
Fertility is a complex thing, involving all manner of influences including genetics, hormones, and lifestyle factors (diet, and also alcohol, smoking, exercise, weight etc).
This groundbreaking study by Ziaei et al. (2024) published in Reproductive Biology and Endocrinology has shone a light on this very important risk factor for female fertility: dietary acid load (DAL).
For years I’ve highlighted that the variables that negatively impact fertility are all linked to DAL: inflammation, oxidative stress, excess weight, poor blood sugar balance, hormonal imbalance, autoimmunity. But this is the first time a study has directly looked at an acidic diet and the risk – and the focus of the case-control study is diminished ovarian reserve (DOR)—a condition linked to reduced fertility and suboptimal responses to ovarian stimulation.
Let’s get into it.
The Study: Dietary acid load and risk of diminished ovarian reserve: a case-control study
What This Study Tells Us
For years, we’ve known that diet-induced acidosis (DIA) is implicated in metabolic disorders, cardiovascular disease, and insulin resistance. What this study adds is a clear association between dietary acid load (DAL) and diminished ovarian reserve (DOR)—a key factor in fertility decline.
In a case-control study of 370 women (120 with DOR, 250 as controls), researchers found that as dietary acid load increased, ovarian reserve markers declined. The primary measures were:
- Anti-Müllerian Hormone (AMH) – a critical indicator of ovarian reserve
- Antral Follicle Count (AFC) – a measure of available follicles in the ovaries
Women consuming diets high in acid-forming foods had significantly lower AMH and AFC levels. The risk of DOR increased by 26% in those consuming the highest dietary acid load compared to those with the lowest intake.
This is important. While previous research has linked individual risk factors—oxidative stress, inflammation, poor metabolic health—to ovarian aging, this study is the first to directly assess the relationship between an acidic diet and ovarian reserve.
What Is Dietary Acid Load, and Why Does It Matter?
DAL refers to the net acid-producing effect of a diet, primarily determined by:
- High-acid foods: Animal protein, dairy, processed foods, gluten, sugar, junk foods, alcohol, caffeine, etc.
- Alkaline foods: Vegetables, salads, low-sugar fruits, nuts, seeds, legumes etc.
[SEE HERE: My Definitive Guide to the Alkaline Diet]
The study used two validated markers to measure DAL:
- Potential Renal Acid Load (PRAL) – Estimates net acid production based on protein, phosphorus, potassium, magnesium, and calcium intake.
- Net Endogenous Acid Production (NEAP) – A ratio-based calculation of protein-to-potassium intake.
A higher PRAL and NEAP score indicates a greater acid load (a more acidic diet), which over time can lead to low-grade metabolic acidosis—a state linked to chronic inflammation, insulin resistance, and now, compromised ovarian function.
As with everything I teach – this is NOT about short-term dietary choices.
Sustained acid load disrupts multiple physiological systems, including the reproductive system, and this study highlights how it may accelerate ovarian aging.
This is why I always make all of my coaching about building this into the Alkaline Life – a long-term, sustainable, effortless lifestyle.
The Mechanisms: How Acidity Impacts Fertility
OK, back to the study. The researchers found that the link between DAL and DOR isn’t just a correlation—it makes sense biologically. The study outlines three key pathways through which excess acidity may contribute to ovarian decline.
1. Increased Oxidative Stress and Cellular Damage
- Ovarian follicles are highly sensitive to reactive oxygen species (ROS).
- A high-acid diet reduces antioxidant capacity, increasing oxidative damage in ovarian cells.
- Lower AMH levels in the study suggest that this oxidative stress is actively degrading ovarian reserve.
2. Chronic Inflammation and Metabolic Dysfunction
- Low-grade metabolic acidosis triggers an inflammatory response.
- This inflammatory state has been linked to insulin resistance, hormonal imbalances, and autoimmunity—all of which negatively impact reproductive health.
- Previous research shows that suppressing inflammation improves ovarian function, further reinforcing the connection.
3. Increased Adiposity and Insulin Resistance
- The study found higher body fat levels in women with higher DAL, aligning with previous research linking acid-forming diets to obesity.
- Excess body fat can drive estrogen dominance, leptin resistance, and insulin dysregulation, all of which impair ovarian function.
- Insulin resistance has a known impact on ovarian reserve, with lower AMH levels reported in metabolically unhealthy individuals.
Do you see something familiar?
My Triple-A model is appearing again! The root cause of all dietary imbalance, disease and health challenge: acidity, oxidative stress and inflammation…
And the way to repair and heal?
- Alkalinity
- Anti-Inflammatory
- Antioxidant-Rich
What This Means for Women Trying to Preserve & Increase Fertility?
The takeaways from this study are clear:
- Dietary acid load matters – it’s not just about individual nutrients but the overall acid-alkaline balance of the diet.
- Metabolic health and ovarian function are deeply connected – weight, inflammation, insulin resistance, and oxidative stress are all part of the same system.
- Reducing DAL can improve ovarian reserve – this study shows there’s a strong case for adopting a more alkaline, nutrient-dense diet to increase fertility
My Final Thoughts
This study represents an important step forward in fertility research, confirming that diet-induced metabolic stress plays a role in ovarian aging.
While your age is not something you can control, diet and lifestyle are within our control and have a HUGE impact on our fertility.
By lowering dietary acid load, managing inflammation, and supporting metabolic health, women can potentially extend their reproductive longevity and optimize fertility outcomes.
And again – this is not about quick fixes or magic bullets—it’s about the long-term impact of daily dietary choices.
Let’s do this,
Ross
