Alkaline water

Alkaline water is a solution of minerals that causes its pH level to rise. Today alkaline water is credited with healing properties for improving bone health, treating cancer, regulating blood sugar/blood pressure and neutralizing acid reflux and heartburn. However, corrosion of pipelines, high sodium content, irritation of eyes, skin, oral mucosa, gastrointestinal tract, metabolic alkalosis and hepatotoxicity are considered to be the harm of the alkaline water. 

In this article we will explain what the proponents of alkaline water and clinical studies say about the properties of the alkaline water.

What is alkaline water?

Alkaline water contains a set of minerals that provide a pH value above 7. However, the pH level is not the only indicator that determines the alkalinity of the water. There is also an “alkalinity indicator” that determines the sum of hydroxide ions (OH – ) and weak acid anions (carbonates, bicarbonates, silicates, borates, sulfites, hydrosulfites, sulfides, hydrosulfides, humic acid anions, phosphates) in the liquid.

Alkalinity of the water is determined by the amount of strong acid needed to neutralize 1 dm3 of the solution. The alkalinity of most natural waters is determined only by calcium and magnesium bicarbonates but the pH level of these waters does not exceed 8.3.

In general, alkaline water is a solution of minerals which causes its pH level to rise.

How to determine the pH level of the water?

Special test strips “litmus strips” as well as pH measuring devices “pH meters” can be used to determine the pH level of the water. If you determine the pH level of drinking water or any other water with a pH meter, pay attention to the calibration of the device. An uncalibrated device may show a pH value that differs by 1-1.5 units from the real value.

WHO recommendations

According to the recommendations of the World Health Organization, the permissible value of the pH index of drinking water is 6.5 – 8.5. In Latvia, the maximum permissible norm for the concentration of hydrogen ions in the water is 6.5-9.5 pH units. If the pH values are higher, the water is not suitable for regular consumption.

The effect of acids and alkalis is determined by their strength and concentration. An increase in the level of acidity or alkalinity of the water in centralized water supply systems can lead to their corrosive effect on pipelines and the release of heavy metals.

Extreme pH values (11 and above) in drinking water cause irritation of the eyes, skin, mouth and throat mucosa. Sensitive people may also experience gastrointestinal irritation. Low pH values produce a similar effect.

Alternative opinion

To understand the arguments used by alkaline water supporters, let’s look at the term “alkaline diet“.

When food enters the human body, it is broken down into certain compounds, including acidic and alkaline substances. A special index PRAL (potential renal acid load) has been developed for evaluating food products. The PRAL indicator shows which products cause the release of more acidic ions in the body and which alkaline.

PRAL calculation formula: PRAL = 0.49 x protein (g/day) + 0.037 x phosphorus (mg/day) – 0.021 x sodium (mg/day) – 0.026 x magnesium (mg/day) – 0.013 x calcium (mg/day).

A food with a positive PRAL is considered acid-forming while a negative PRAL means the food is alkaline. In general, fruits, vegetables, potatoes, wine, and soda are considered alkaline, while grains, meat, dairy, fish, and beer are considered acidic.

What role does the water play in this situation? According to alkaline water supporters, modern diets are acid-promoting so drinking alkaline water is a way to neutralize this acidic environment.

Alkaline water preparation methods

The most common and cheapest method of producing alkaline water is to add certain reagents to the water. Everything that is added to the water is actually chemicals. Let’s look at several methods for preparing alkaline water taking into account chemical aspects.

1. SODA (NAHCO 3 ) AND TABLE SALT (NACL)

In different sources the recommended proportions of soda and table salt vary from “on the tip of a knife” to “half a teaspoon” per liter of the water. Such recommendations sound wrong because the content of alkali ions and the pH level of the solutions can vary significantly.

An example of alkalizing water: on the tip of a spoon there are about 3 grams of soda and about 5 grams of salt which will make a solution of 0.3% soda and 0.5% salt. Simple mathematical calculations show that:

• the approximate pH level of such a solution is 9.5;
• alkalinity: 30 mg-equiv/l which is 4.5 times higher than the standard value;
• sodium content: 6000 mg/l which is 30 times higher than the maximum amount of salt per day.

Such water is not drinkable, it cannot be consumed regularly.

2. LEMON

The second method of preparing alkaline water is to mix a lemon with two liters of clean water. According to mathematical calculations: one lemon is about 6 – 10 grams of citric acid (depending on its size). For calculations we choose the average value, i.e. 8 grams of citric acid. Distilled water has a pH value of 2.28, tap water can be slightly higher, i.e. up to 4. This pH is acidic and not alkaline. But “alkaline diet” advocates believe that adding an even more acidic supplement to an “acidic” diet will cause an alkaline reaction in the body.

It is important to remember that water with lemon should be used with caution as it can damage tooth enamel, irritate the mucous membrane and the esophagus.

3. IONIZER

This method is no less controversial. The ionizer device works thanks to the electrolysis process. It usually consists of a container separated by special ion-selective membranes and a set of electrodes: cathodes and anodes. A constant electric current is passed through the water.

Such devices, depending on the intensity of the process and the number of electrode plates, provide a different pH level of the water (some even allow it to be adjusted). On average, the lower limit of the pH level is 4.5 and the upper limit is 11. However, they do not work effectively when using highly purified water as well as tap water because they concentrate harmful impurities (e.g. nitrates together with hydroxide ions).

The question about the purity of the source water is very important because it is impossible to talk about the benefits of drinking such a liquid that has not been purified from the basic pollutants.

4. ALKALINE MINERAL WATER

The mineral composition of alkaline mineral water usually contains a lot of bicarbonates as well as other alkali (sodium, potassium) and alkaline earth (calcium, magnesium) metal salts. Their pH level ranges from 7.5-9 pH units. Such mineral waters are not recommended for systemic drinking as many chemical elements significantly exceed the regulated standards.

What do clinical studies say?

Science generates information in the form of hypotheses which are disproved or confirmed. Many dietary trends are hypothesized and remain relevant even after scientific disproof. Although the origin of the alkaline water trend have not been found, there has been a lot of research about the use of alkaline water.

BONE HEALTH AND OSTEOPOROSIS

The effect of high pH water on bone health is a frequently discussed topic in the scientific literature.

In 2009 (Wynn, Krieg, Aeschlimann, Burckhardt) conducted a study in which the relation of water acid-base balance to bone resorption was investigated. It is a process in which old bone cells are broken down to be replaced by the new ones. The lower the resorption rate and the higher the mineral density, the stronger the bones. In the study young women were divided into two groups who drank two different types of water (1.5 liters per day). As a result of the study it was shown that the acidic and calcium-rich water did not affect the bone condition. The alkaline and bicarbonate-rich water caused a certain decrease in the destruction of bone tissue.

An extended review of 55 scientific publications found no strong evidence for a relationship between acid-base balance and osteoporosis as a consequence of resorption. Therefore, alkaline water is mainly recommended for the prevention of bone diseases and not for the treatment of diseases.

ALKALINE WATER AND CANCER

In 2016 (Fenton, Huang) conducted a large-scale analysis of publications regarding the effects of alkaline water on cancer. During the study 252 abstracts of scientific articles and more than eight thousand citations were analyzed. However, no publication was found with sufficient research credibility to show the benefits of using alkaline water in the treatment of cancer.

ACID REFLUX OR HEARTBURN

A burning sensation behind the sternum and in the esophagus as well as a sour and bitter taste in the mouth occurs when gastric juice enters the esophagus (due to the strong hydrochloric acid pH < 3). Treatment usually consists of conservative diet and using medications called proton pump inhibitors (systemically affect the causes of heartburn) and antacids (neutralize acidity).

Alkaline water in this case acts as an antacid that neutralizes the acidity. For this reason alkaline water improves well-being. Soda is also used to treat heartburn.

There are small studies that support the fact that alkaline water can benefit people with gastrointestinal problems. There is a study that confirms that water with a pH of 8.8 can destroy the enzyme involved in the production of gastric juice – pepsin. It is stable up to a pH value of 7.4 and its destruction causes a decrease in acidity. However, it should be noted that these studies were conducted in the laboratory and large-scale clinical trials are needed to confirm the effectiveness of alkaline water.

SUGAR LEVEL AND BLOOD PRESSURE

In 2001, clinical trials were conducted in patients with type 2 diabetes. Monitoring was done within 3-6 months after drinking the alkaline water. The obtained results confirmed the lowering of blood pressure, sugar and cholesterol levels.

In 2017, similar studies were conducted again. The diabetics of the second group were divided into 4 groups of 7 people each and consumed water with different pH levels. It should be noted that the changes in the sugar level were highly dependent on the pH level:

• consumption of the water with a pH value of 7 did not show significant changes;
• water with a pH value of 8.5 affected the average sugar level, lowering it by an average of 3%;
• using water with a pH value of 9.5 and 11.5, the blood sugar level decreased by an average of 6%.

It is important to understand that no long-term studies were conducted so the duration of using alkaline water is limited to 6 months.

Harm and possible contraindications

Using alkaline water with added salt and soda poses a potential risk of exceeding the permissible sodium content. In addition, a stable total excess of alkalinity in the body causes metabolic alkalosis. This disease is associated with a decrease in carbon dioxide and bicarbonate levels in the blood.  It is often accompanied by a lack of potassium and sodium. Symptoms include nausea and vomiting, hand tremors and convulsions, tingling in the extremities or face and confusion. Alkalosis can also cause a decrease in free calcium in the body leading to bone problems.

Therefore, the “treatment” of serious diseases with alkaline water can lead to life- and health-threatening consequences.

ALKALINE WATER HEPATOTOXICITY

In November 2020, in the state of Nevada (USA) a series of acute liver failure occurred. Five children between the ages of 7 months and 5 years needed to transplant the liver. In the search of the cause of this phenomenon the medical staff questioned the children’s families. The survey revealed that all the families had used bottled alkaline water “Re2al Alkalized Water”. This manufacturer’s water has been completely withdrawn from the U.S. market. But it is still unclear what exactly caused the liver problems. This fact can be related to the production process, to the packaging or transportation.

Conclusions

• Alkaline water is a solution of minerals that causes its pH level to rise.
• There is not enough reliable scientific evidence for the long-term positive effect of using alkaline water.
• Making alkaline water at home using improvised means can be harmful to health. It is especially dangerous for people who suffer from kidney or cardiovascular diseases.
• Using an ionizer is expensive. Its use using untreated tap water leads to the concentration of harmful substances.
• Drinking water must be clean, safe and meet drinking water requirements.