Alkaline Water: High pH or High BS?

You’ve seen the posts on social media by health and wellness gurus touting the benefits of alkaline water, which range from the believable (increased hydration) to the miraculous (disease prevention). The explosion of interest in this alleged wellness aid sent me straight to PubMed in search of scholarly research to support or disprove the proposed effects of alkaline water. Imagine my surprise when I uncovered a tale of deceit, corruption, and century-old science.

What is Alkaline Water?

This trendy wellness product hit the scene a few years ago following in the footsteps of the alkaline diet, which claims that acidity in the blood creates an environment for diseases and cancer to thrive. The way to combat blood acidity, the diet claims, is to eat plenty of alkaline foods to increase the blood’s pH. Bottled water companies quickly capitalized on this health craze, selling high pH water with bold claims such as increased hydration, quicker recovery, and decreased likelihood of cancer and diseases.

As the old saying goes, if something sounds too good to be true, it probably is. Robert Young, the creator of alkaline diet, was arrested in 2014 on 18 felony charges of practicing medicine without a license and was sentenced to 3 years in jail. Young’s basis for the alkaline diet? His belief that acidic blood will convert blood cells into pathogenic bacteria. If this theory sounds a little...archaic, that’s because it is. This hypothesis was put forth by Antoine Béchampe in the 19th century and was put to bed by Louis Pasteur's prevailing germ theory.

What Does Modern Science Say?

While overly acidic blood isn’t going to turn our blood cells into pathogens, it still isn’t great for our bodies, which attempt to maintain a normal pH of about 7.4 on a scale of 1-14, one being the most acidic and 14 being the most basic. Deviations from normal pH can interfere with the normal function of important enzymes, while severe changes can lead to major complications and even death. Fortunately, our bodies have several sophisticated systems that effectively regulate pH.

To understand these systems, we need to know that pH stands for power of hydrogen, and is a measure of the concentration of hydrogen ions in a solution. Our bodies’ maintenance of pH is all about managing these hydrogen ions in our body, which it does in three distinct ways:

  • Buffer Systems: These are fast-acting but incomplete and work to temporarily bind free hydrogen ions. They can change the pH of a solution, but not eliminate hydrogen ions from the body. One of the most important buffers is sodium bicarbonate because it is readily available in the body and easily binds to hydrogen ions to form carbonic acid, which can be easily removed through respiration.

  • Respiratory Mechanisms: Hydrogen ions that have bound with bicarbonate become carbonic acid, which separates into water and carbon dioxide. If our blood becomes too acidic, our bodies can increase respiration to breathe out more carbon dioxide. This process decreases the level of carbonic acid in the blood and brings pH back to a normal range. If the body is too alkaline, respiration will slow to keep more carbonic acid in the blood.

  • Renal Mechanisms: Our kidneys are the more precise and complete regulator of pH. They work to balance pH by excreting either hydrogen ions (when pH is too acidic) or bicarbonate (when pH is too basic). However, this process is the slowest of the three, taking several hours or even days.

Most of the time, our bodies are able to effectively regulate pH using these mechanisms. However, extreme conditions can cause the body to become too acidic (acidosis) or too basic (alkalosis). Metabolic acidosis, for example, can be caused by circumstances that involve high levels of fat metabolism, such as starvation, or metabolic disorders, such as Type 2 diabetes, which releases ketoacids into the blood. Respiratory acidosis can be caused by conditions such as Chronic Obstructive Pulmonary Disease (COPD) or emphysema which interfere with normal breathing. Alkalosis is possible as well, and is usually induced by severe loss of fluids through diarrhea or vomiting.

If you don’t have any of these conditions, your body regulates pH just fine on its own. In fact, excessive intake of alkaline drugs or substances is one of the main causes of alkalosis, which is just as detrimental and dangerous as acidosis.

You Mentioned PubMed?

So we know the science behind the overall alkaline diet craze is bunk, but is there any research to support claims made by alkaline water enthusiasts? Not really. No studies exist evaluating alkaline water’s role in cancer prevention or treatment, or any other benefits other than increased hydration. A single study examining the hydrating effects of alkaline water was published in 2016. The Essentia Water website lists this study as evidence that its product is better at rehydrating stating:

“The clinical trial, published in the Journal of the International Society of Sports Nutrition (JISSN), measured how well a leading bottled water and Essentia Water rehydrated participants after moderate aerobic exercise. The results showed that Essentia Water was more effective at rehydrating.”

However, the Essentia Water website leaves out a few important details of this study. First, while the study measured four markers of hydration, only one marker proved any different between the groups. The study concluded that a statistical difference in blood viscosity was seen, but that the three other markers studied, plasma osmolality, bioimpedance, and body mass change, all widely studied and accepted hydration markers, showed no statistical difference. The study also notes that the difference in blood viscosity was only significant when using a comparison of percent changes over 120 minutes and that no statistical difference for blood viscosity could be detected using absolute differences at multiple time points. What does this mean exactly?

Well, percent changes can be misleading. If I have one penny, and I acquire an additional penny, my wealth has increased by 100 percent. The absolute value of my wealth has increased by one cent, but the percent change of my wealth is 100 percent. Percent change sounds a lot more impressive, right? The Essentia Water study had to use percent changes to show statistical significance because the change in absolute value was not. Further, while the actual data was kept confidential, graphs were released to illustrate changes to hydration markers. These graphs include the standard of error bars. These bars represent a margin of error in statistical analysis. When the bars overlap, the difference in the data sets is not statistically significant. The graph for change in blood viscosity, shown below, may look like Essentia water made a difference, but notice that the red and blue bars overlap, meaning that the difference is not statistically significant.

Screen Shot 2018-07-02 at 10.24.18 PM.png

Finally, and perhaps most telling, the study was funded by, you guessed it, Essentia Water. Five of the six authors of the study list competing interests, including one author who received consulting fees and stock options from Essentia Water. His role in the study? Designing it.

h2 in the know

While health and wellness products like alkaline water may be alluring (who doesn’t want a product that will make it easy to live more healthfully?), it is important to remember that at the end of the day, these are PRODUCTS. That is, they are designed to be sold to consumers for a profit. Companies often latch onto, or even form around, wellness crazes that may or may not be backed up by science. And if the science isn’t there, guess what? Greasing the right palms may be all it takes to create that science. The best thing you can do as a consumer is to do your own research. And If deciphering published research isn’t your idea of a fun Saturday night, look to fitness and nutrition professionals who have devoted significant amounts of time to understanding the science behind these disciplines for guidance. When it comes to alkaline water, this fitness professional says fill up your water bottle at home, and save your hard earned cash for your legging collection.