Alkaline Water

Pure water has a pH (power of Hydrogen) level of 7

A lower number is acidic, a higher number is alkaline, or base.

pH is a logarithmic scale, a difference of one pH unit is equivalent to a tenfold difference in hydrogen ion concentration.

Most water extracted from the ground to use as drinking water, is naturally slightly alkaline from chalk or limestone. Where this is high, it is often referred to as “hard water” and may be seen as a limescale deposit in a kettle.

Because limescale can fur up mains water distribution pipes, some water companies add a small amount of acid to neutralise it.

However, that may cause other problems.

“Over the past several years, many water treatment plants in the southeastern and midwestern United States have faced troubles with existing piping systems that used sulphuric acid as a chemical dosing method.” (Water treatment piping systems pass the acid test)

Corrosive water can dissolve metal plumbing components causing unsafe levels of copper and lead and pinhole leaks. (Corrosive Water Problems 2015 Penn State Extension)

According to APS Water Filtration and Lab Products: “Most city tap water in the U.S and other countries is alkalized to raise the pH to about 8.5 on average. This is because low pH water tends to dissolve things like concrete drain pipes and copper piping, while high pH tends to form deposits which actually thickens the same pipes. The reason is that thicker pipes rupture less often but plug over time.” (AlkalineWater - Simple Science)

If acid reflux is a problem in the human body, some nutritionists asked the question, would drinking alkaline water actually help reduce acidity?

Water may be made more alkaline by adding sodium bicarbonate or by using a water ioniser.

The outcome was some companies started making profits out of selling bottled alkalised water and water ionisers.

Arguments FOR Alkaline Water

A voice specialist in New York, who provided the terms LPR and silent reflux, amongst others, to describe extra-oesophageal reflux, found many of those seeking her help were found to have pepsin in their throats. (Pepsin is normally only found in the stomach; it’s presence in the throat confirm that gastro-oesophageal and extra-oesophageal reflux has occurred.)

She went on to postulate that pepsin may be the cause of LPR and published this paper in 2012 to support her theory, Potential benefits of pH 8.8 alkaline drinking water as an adjunct in the treatment of reflux disease, which concluded, “Unlike conventional drinking water, pH 8.8 alkaline water instantly denatures pepsin, rendering it permanently inactive. In addition, it has good acid-buffering capacity. Thus, the consumption of alkaline water may have therapeutic benefits for patients with reflux disease.”

It started with an assumption that, "pepsin is fundamental to the pathophysiologic mechanism of reflux disease," claiming it causes reflux rather than observing pepsin is just proof of it. She was a director of a company selling water ionisers at the time.

A study in 2017, A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux, found, “In this cohort study that included 184 patients, there was no significant difference in reflux symptom index reduction between patients treated with alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions vs those treated with proton pump inhibitors (PPI) and standard reflux precautions.

Meaning: The symptoms of LPR can improve with alkaline water and a plant-based diet with results not significantly different from the use of a standard PPI regimen.”

However, the wording of the press release inferred the diet was better, whilst totally ignoring the fact that PPIs reduce acid not reflux. This led to a number of headlines worldwide such as this: “Why the Mediterranean diet is the best cure for acid reflux”. - The article also went on to include the typical scare mongering that PPIs are dangerous.

The study was funded by the Voice Institute of New York which was established by the author of the paper referred to above. It coincided with her publication of a new book about the Mediterranean Diet.

Arguments AGAINST Alkaline Water

This paper, Systematic review of the association between dietary acid load, alkaline water and cancer, published in British Medical Journal in 2016, concluded:

“Despite the promotion of the alkaline diet and alkaline water by the media and salespeople, there is almost no actual research to either support or disprove these ideas. This systematic review of the literature revealed a lack of evidence for or against diet acid load and/or alkaline water for the initiation or treatment of cancer. Promotion of alkaline diet and alkaline water to the public for cancer prevention or treatment is not justified.

Healthfully is a website devoted to promotion of healthy choices and lifestyle. They felt compelled to provide these pages, updated in 2017:

Negative Effects of Alkaline Water and The Dangers of Alkaline Water in which their doctors say,

“Alkaline water has no effect upon the pH levels of the physical body. After ingestion, alkaline water is almost immediately neutralized by hydrochloric acid present in the stomach. After leaving the stomach, water is combined with pancreatic enzymes, transforming the final product into an alkaline agent once again. Regardless of whether water is alkaline or acidic to begin with, the digestive processes of the body are able to transform the pH balance of all liquids in the digestive tract into what the body requires.”

“Drinking alkaline water also can negatively affect your stomach. The stomach produces acid to break down and digest food and drink. When you drink alkaline water, the stomach attempt to bring down the pH of the water. It does this by creating more acid, which can cause indigestion or complicate a condition such as an ulcer.”

Scientists other than doctors have waded into the discussion.

Stephen Lower, a retired faculty member of the Department of Chemistry at Simon Fraser University (“Chemistry is my favorite subject, and I hate to see it misused to confuse, mislead or defraud the public.”), felt strongly enough to produce this website, "Ionized" and alkaline water: snake oil on tap, providing a thorough description well worth a read.

These are some of his bottom line quotes:

    • "Ionized water" is nothing more than sales fiction; the term is meaningless to chemists.
    • Pure water (that is, water containing no dissolved ions) is too unconductive to undergo significant electrolysis by "water ionizer" devices.
    • Pure water can never be alkaline or acidic, nor can it be made so by electrolysis. Alkaline water must contain metallic ions of some kind — most commonly, sodium, calcium or magnesium.
    • The idea that one must consume alkaline water to neutralize the effects of acidic foods is ridiculous; we get rid of excess acid by exhaling carbon dioxide.

In this article, Alkaline Water Hoax – It is Simple Science, the authors state: “The people selling Alkaline water are making false medical claims which give people false hope or makes them not look for traditional treatments. It is sold as a food supplement so there is no regulation. It is the same way they can sell weight loss and male enhancement products that do not work. Snake oil products come along all the time. It is amazing how we are all so desperate that we tend to want to believe anything.”

Rather than peddle the scaremongering stories that some newspapers seem to favour, the New York Times printed this article in 2018, Is Alkaline Water Really Better for You? In which they say,

“Despite the claims, there’s no evidence that water marketed as alkaline is better for your health than tap water.”

“there’s no evidence that drinking water with a higher pH can change the pH of your body, or even that this outcome would provide benefits."

Similarly, in 2019, the Washington Post printed this article, Is alkaline water really better for you? in which they say, "Not only is alkaline water not helpful, drinking it may have drawbacks. Ionized or enhanced water isn’t necessarily purified. Make sure water you drink often is properly filtered and/or from a clean source without contaminants."

“It’s all about marketing,” said Tanis Fenton, a registered dietitian and epidemiologist at Cumming School of Medicine at the University of Calgary. “There is no science to back it up.””

Do beware of “Quacks”.

One such goes by the name of “Dr Robert O Young” who provides the website called pHMiracleLiving, which says, “The science of Dr. Robert and Shelley Young and the pH Miracle lifestyle and diet have been set forth in best-selling books including The pH Miracle, The pH Miracle for Weight Loss, and The pH Miracle for Diabetes and the recently released The pH Miracle Revised and Updated. These books contain the Youngs' philosophy and methodology, including diet meal plans and healthy recipes beyond what can be found in the popular Back to the House of Health cookbooks.”

However, he has been reported to FDA on many occasions and "was sentenced to prison for practicing medicine without a license” when someone died after taking his advice instead of following standard treatment.

There are many other papers I could cite but I’ll leave the last word to Stephen Lower, mentioned earlier, for those who claim “drinking ionized water does make me feel better!”

“The most likely reason for this is the placebo effect. Studies have shown that placebos can relieve the symptoms in about 40 percent of those who suffer from chronic ailments. They are probably even more effective for those who are inclined toward "alternative medicine" or the "wellness" industry. In other words, if you "believe" that something might help, it may well do so, and the more people are made to pay for it, the more eager they will be to have their beliefs confirmed.”

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