Overview
Drinking alkaline water is a growing trend in dieting and adds to the growing space afforded mineral water in general. It might seem odd that such a product has come to the fore in recent times. Alkaline waters have been in the marketplace for many years and there is a lot of perceived health interest in this type of product. It seems this might be as much to do with celebrity endorsement. People like Donald Trump, Barack Obama, Robert Downey Jr and Bill Gates are all advocates for drinking what many really perceive to be a faddy water.
We all know that drinking more water than we generally do would give us better health. You only have to visit a UK hospital to see the number of initiatives encouraging us to drink some water whilst we wait.
The growth in all sorts of water products from mineral and spring water to functional water products which contain vitamins, activated carbon and the like has risen steadily. One of those developments in water is alkaline water.
Alkaline Water And The Fit With Alkaline Diets
Alkaline water, electrolyzed water and what might also be described as low-acid water has been a popular choice in Japan for a number of years but has started to gain credence in the USA. It has become part of the so called alkaline diet or acid-ash diet which has been around for many years. Most of the food eaten in this diet is between 60 and 80 % alkaline-forming foods which according to some web-sites ‘melt away excess body fat’. Here, people are asked to adopt this particular diet to avoid diseases such as osteoporosis, cancer and gastro-intestinal disorders (see the general web reference list at the end). It is also now being touted for treating Type 2 diabetes. None of these claims have any truth however as the clinical evidence is so few and far between.
Over 15 years ago in 2004 there was a study at the University of Texas Health Science Center at San Antonio (Texas, USA) into electrolyzed alkaline drinking water reported at the IFT Annual Meeting in Las Vegas. That idea was based on Japanese interest in generating safe drinking water which had an enriched mineral and antioxidant content through electrolysis. The use of such technology in Japan still continues and is also used as cooking water in some parts of the country. One finding was increased superoxide activity due to proton donation which caused an increase in dissociation activity with increased scavenging activity. This increase in what is a positive effect occurred through activated and dissolved hydrogen in the ‘reduced’ water. What promoted the interest was improving or even preventing loss of the immune system during aging or various disease states (Fernandes, 2004). What spurred this interest was research on improvements in health to mice with autoimmune disease which ‘revealed a therapeutic role’.
The antioxidant effect of alkaline EO water itself is relative weak when compare with other traditional antioxidants like vitamin C and vitamin E.
It’s also worth pointing out the branding of low-acid water too which is touted for treating skin complaints. This is a phenomemon in its own right but not as extensive as that for alkaline water. Again there is not enough evidence to support any claims made.
The pH Scales In Relation To Water
The first point to note is that pH refers to the proton (hydrogen ion) concentration in water. This concentration is measured on a pH scale between 0 and 14. This is a logarithmic scale which works in the same way we use The Richter Scale for measuring the strength of earthquakes. The proton concentration is highest at pH 0 and lowest, almost absent at pH 14. Water is neutral in pH which comes out at pH 7. A water with a pH less than 7 is acidic and as it moves further away from that pH value, it becomes more acidic. Likewise, a water with a pH above 7 is termed as alkaline and becomes increasingly more alkaline as the pH rises towards 14. Apologies to all those who understand this stuff but it is worth repeating for clarity.
On average, the pH levels should be approximately pH 7.36 for our blood, leaving our blood somewhere around a 60 to 40 alkaline-to-acid ratio.
Acidity and alkalinity is a different concept ! This concept refers to the amount of acid or alkali in water and is measured by titration. It is also a measure of buffering capacity. Products which have high acidity need not necessarily have a more acidic pH than those with a lower acidity.
What Is Alkaline Water ?
Alkaline water is a type of water with a higher pH than regular water and a negative oxidation reduction potential (ORP). The best type is naturally alkaline spring water (Shirahata et al., 1997) which means that it has a pH greater than 7.
The thinking goes like this: Too many hydrogen ions means less oxygen is available to the cells, resulting in higher acidity when pH drops. Fewer protons mean more oxygen is available, leading to a more alkaline, or basic, state. There is no known disease that can survive in an alkaline state.
Because it has a higher pH level, alkaline ionized water is supposedly more beneficial than your basic tap water. It typically clocks in with a pH level around 8 or 9 while the pH of water is usually between 6.7 and 7.0. It’s also claimed that alkaline water offers many more key minerals the body requires to function properly. These include minerals such as calcium, potassium, sodium and magnesium. It is fair to say that certain types of natural hard water which also has significant amounts of bicarbonate could also be classified as an alkaline water.
Alkaline water can also be added to fruit juices to improve their antioxidant capacity (Kim & Hung, 2009). Apple juice was treated this way and its antioxidant potential rose when the alkaline water was added to it according to higher TEAC and ORAC readings.
The Function Of The Minerals
The four main minerals which are listed on most ingredient lists for water are the following:-
Calcium is required for bone building as well as strengthening them. It is also important for a healthy blood circulation system.
Magnesium in combination with other compounds helps convert our food into energy. It also acts to maintain heart, smooth and skeletal muscle action, proper functioning of nerves, heart and kidney.
Sodium is one of those minerals for maintaining blood pressure, balancing fluid strength (osmolality) in the body and affects muscle movement.
Potassium, like sodium helps maintain muscle relaxation and contraction, which is extremely important around the heart, and also aids in digestion and fluid elimination.
The body works hard to naturally keep the blood tipping toward an alkaline state and will take from stored reserves whenever necessary to keep it balanced.
Alkaline water which is produced by electrolysis of dilute NaCl and KCl solutions is used to reconstitute fruit juices such as apple juice (Kim & Hung, 2009). A process involving electrolysis of water can produce alkaline EO water (reduced water), which has strong reduction potential, low dissolved oxygen, high dissolved hydrogen and function as antioxidants to neutralize reactive oxygen species. The antioxidant effect of alkaline EO water itself is relatively weak when compared with other traditional antioxidants like vitamin C and vitamin E.
In a number of brands you will see fulvic minerals which covers a vast range of trace elements that seem to cover a third of the periodic table. These are added to alkaline water but without having any clear function other than the fact they are trace minerals with reputed health benefits. What benefit is Yttrium for example in the body ?
Taste
Alkaline electrolysed water has a taste which is dependent on water hardness. The addition of calcium and magnesium has an important sensory impact (Koseki et al., 2005).
Alkaline Water And Dieting
Part of the popularity for alkaline water comes from a health conscious populace who have started following an alkaline diet or at the very least hydrate themselves more effectively. From a digestion perspective, all foods including water are effectively acidified in the stomach which will reduce the pH to between 1 and 2. Unfortunately clinical and medical research into alkaline water is highly limited and clearly more effort needs to be expended on this type of product. It is odd to say for example that acidified water lowers the pH of blood because blood itself is highly buffered to avoid such changes.
Kidney Function
One study in mice considers electrolyzed reduced water (ERW) to be a good way of protecting the kidneys from cancer drug damage. Interestingly, ERW was claimed to protect the kidneys of these mice from the cancer drug cis-platin. The thinking was that ERW increased the antioxidant levels which inhibited lipid peroxidation.
Lipid peroxidation is a free- radical-medicated chain of reactions which when initiated produces oxidative deterioration of polyunsaturated lipids and fats.
Gastro-Intestinal Benefits Of Alkaline Water
One piece of research suggests that alkaline water might help those with severe acid reflux or with acidosis although this needs much further investigation. Gastric reflux (acid reflux) is a very common condition and is a causative agent of the much serious condition, esophageal adenocarcinoma.
In many senses the idea of suppressing throat and esophageal cancer came from the sense that there was a prevalence of acidic food in the US diet (Koufman, 2011). [Admittedly, high acid foods are relatively safe because a low acid pH is an important hurdle to growth of spoilage bacteria.]
Imbibing an alkaline water (pH 8.8) helped neutralize the acid contents of the stomach which reduced the generation of a highly acidic stomach (Koufman & Johnstone, 2012). One of the components in the stomach which is highly active is the enzyme pepsin. This enzyme which is essential for digestion of proteins is believed to play a role in causing ongoing damage to cells in the larynx, pharynx and down through the esophagus. When pepsin is exposed to alkaline water where the pH is greater than 8 then this enzyme is deactivated. Having said that, the stomach will continue to reduce the pH to a level where enzymes needed for digestion are able to function to their optimum.
One study on 184 people found no significant difference in the symptoms of reflux when they received either alkaline water, a plant-based Mediterranean-style diet with precautionary reflux precautions and with proton pump inhibitors (PPIs) and precautionary reflux precautions (Zalvan et al., 2017).
Alkaline water though might be a useful aid in treating reflux. It explains why some marketing has taken this to an extreme but attracted the ire of advertising agencies.
Cancer
At this moment in time there is no evidence that alkaline water helps anyone reduce the risks of cancer even though there has been a great deal of hype about the properties of this type of water (Fenton & Huang, 2016). It is worth noting though that there are some foods which contribute to a low-grade type of metabolic acidosis. This aspect has been linked to an increased risk in breast cancer for example but the evidence here is scant (Park et al., 2018).
Immune Benefits
A number of years ago studies on drinking alkaline water by autoimmune suffering mice demonstrated improvements in their immune system (Fernandes, 2004).
Anti-Aging Benefits
Probably none ! Plenty of clinical research especially on the elderly needs to be conducted to show if there are any anti-aging benefits. It doesn’t appear to fit with current thinking and there is plenty of scepticism surrounding the advocacy of such a product for minimising skin aging for example.
Diabetes
At this moment in time there is some evidence for an association between type-2 diabetes and the dietary acid load which relates to the level of acid based foodstuffs. However much more definitive research is required before any firm conclusions can be drawn on this association (Emamat et al., 2019).
Potential Issues With Alkaline Water
Generally, alkaline water is safe to drink but there are a few issues which may produce unwanted side effects. An alkaline product including water can lower the natural stomach acidity. In a number of cases this is might be helpful feature if the stomach is too acid. Otherwise the effect on the body is rather pointless ! In fact the body will always buffer the blood to a very specific range of between 7.35 and 7.45
One of the main issues is poor marketing. A few brands have been caught out by misleading claims. One was Alka Power which was found by the advertising Standards Community Panel to have made some incorrect claims. One being that it inhibited pepsin in the stomach and increased bone density. The web-site offers highly controversial advice especially where treating diseases is concerned. It’s worth noting though that of all the products promoted in recent times, the marketing activity can be quite extreme.
If you test bottles of alkaline water you may be rather disappointed with the pH result. Some litmus paper tests according to the BDA suggest the pH reads 7.0 rather than anything remotely alkaline.
Brands Of Alkaline Water
Some of the main brands are The Alkaline water Company Inc. (USA) which produces under the brand name Alkaline88®. It has a proprietary electrolysis process for generating this type of water. The product offers consumers the unique opportunity to purchase alkaline water in conveniently packaged 500-milliliter, 700-milliliter, 1-liter, 1.5-liter, 3-liter and 1-gallon sizes. Visit: www.thealkalinewaterco.com
Look out for Kroger ® Alkaline Water which is US too and uses reverse osmosis to purify the water and then adds electrolytes to generate a pH greater than 9.5 as well as their spring water brand.
Alka Power, an Australian brand based in Mittagong, New South Wales is a leading water in Oceania. Look out for Core and Essentia too. A brand that appeared in 2013 but has been around for awhile is getblk. (https://www.getblk.com/) which focusses on fulvic acid rather than make claims on alkaline water. The colour of the water is black which might be off putting but there is clearly some interest in the range of minerals their products contain.
Conclusion
At this moment in time there is very little evidence to support alkaline water as a health product. It is noticeable that the product is heavily hyped and extraordinary claims, virtually all in error are being made for this product. Best to stick to drinking tap water for the time being !
References
Fernandes, G. (2004) 73-2 Electrolyzed alkaline drinking water in health and disease. IFT Annual Meeting. Abstract. July 12-16, Las Vegas, NV USA
Kim, M.J., Hung, Y-C. (2009) Enhancing the antioxidant capacity of reconstituted apple juice with alkaline electrolyzed (EO) water. IFT Annual Mtg. Abstract. June 6-9, Anaheim, CA. USA
Koseki, M., Fujiki, S., Tanaka, Y., Noguchi, H., & Nishikawa, T. (2005). Effect of water hardness on the taste of alkaline electrolyzed water. Journal of Food Science, 70(4), S249-S253.
Koufman JA. (2011) Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann. Otol. Rhinol. Laryngol. 120 pp. 281-7. https://doi.org/10.1177/000348941112000501
Koufman, J. A., & Johnston, N. (2012). Potential benefits of pH 8.8 alkaline drinking water as an adjunct in the treatment of reflux disease. Annals of Otology, Rhinology & Laryngology, 121(7), pp. 431-434. https://doi.org/10.1177/000348941212100702
Park, Y. M. M., Steck, S. E., Fung, T. T., Merchant, A. T., Elizabeth Hodgson, M., Keller, J. A., & Sandler, D. P. (2018). Higher diet‐dependent acid load is associated with risk of breast cancer: Findings from the sister study. International Journal of Cancer. 144(8) pp. 1834-1843 https://doi.org/10.1002/ijc.31889
Shirahata, S., Kabayama, S., Nakano, M., Miura, T., Kusumoto, K., Gotoh, M., … & Katakura, Y. (1997). Electrolyzed–reduced water scavenges active oxygen species and protects DNA from oxidative damage. Biochemical and Biophysical Research Communications, 234(1), pp. 269-274.
Zalvan, C. H., Hu, S., Greenberg, B., & Geliebter, J. (2017). A comparison of alkaline water and Mediterranean diet vs proton pump inhibition for treatment of laryngopharyngeal reflux. JAMA Otolaryngology–Head & Neck Surgery, 143(10), pp. 1023-1029.
Popular Dieting References
Eating Veggies. (2019) https://eating-veggies.com (accessed 21st March 2019)
Marra, J. (2014) Cause, cure, and cancer free: how I became a cancer free escapee. Pennsylvania: Sakura Publishing and Technologies.
Young R.O. (2002 The pH miracle—balance your diet, reclaim your health. New York: Warner Books.
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