Alkaline Water

There is a lot of hype about alkalizing the body and a belief that alkaline water can do this. Does acid cause issues in the body?

The science

Normal drinking water has a pH of 7. pH is the reading of acid and alkalinity of substances, based on a scale between 0 and 14, the lower the number, the higher the acid content. Alkaline water has a pH of about 8 or 9 and it is this higher alkalinity content that is believed to neutralize acid content of our body.

Water can be naturally alkaline in nature such as found in spring water. Commercial Alkaline water is commonly produced by an “ionizer,” a device that changes the chemical composition of water.

Acid-base balance

The body is pretty amazing! By using ions, it is able to regulate the acidity of its fluids. Ions are molecules of atoms that have gained or lost electrons and therefore have electrical charges. The body must maintain this balance within a narrow range to avoid life-threatening consequences. Normal energy metabolism generates hydrogen ions, (H+), along with many other acids, a high concentration of which would be very acidic.

The body is able to regulate pH through three systems.

1. Buffers in blood – Bicarbonate (base) and carbonic acid (an acid) as well as some proteins, act as neutralisers of acids or bases.  They are considered the first line of defence against changes in acidity. 
2. Through respiration in the lungs – If too much acid builds up, respiration of carbon dioxide increases, if too much base, the respiration of carbon dioxide decreases. It is the exhaling of carbon dioxide that can restore homeostasis (bring back balance).
3. Excretion in the kidneys – long term control of acid-base is maintained by the kidneys. By selecting which ions to excrete and which ones to retain, the kidneys are able to adjust the acid-base of the body. The urine’s acidity fluctuates to adjust this balance. Also influenced by the brain.

Normal cell metabolism depends on the maintenance of blood pH within very narrow limits (7.35-7.45). A small deviation from these readings can have a disastrous effect on the body such as reduced oxygen delivery to tissues, electrolyte disturbances and changes in heart muscle contractility; survival is rare if blood pH falls below 6.8 or rises above 7.8.

Acid-base status is often disturbed during critical illness.

Too much acid = acidosis - death, too much base = alkalosis – death

Disturbances of Acid-Base Balance

Most acid-base disturbances result from:

• disease or damage to the organs (kidney, lungs, brain) of acid-base homeostasis
• disease which causes abnormally increased production of metabolic acids and thus overwhelm homeostatic mechanisms
• medical intervention (e.g. mechanical ventilation, some drugs)

What is the issue with acid?

We need acidity. Acid is used by the stomach to digest protein and kill any potential pathogenic bacteria ingested. 

Acid on our skin helps prevent pathogenic bacteria from causing infection, such as can happen with acne, eczema or more serious diseases like cellulitis when the skin protection barrier is broken.

When things go wrong medically with acid-base homeostasis, it is often related to the systems involved in acid-base transport in the kidneys. The brain also plays a role when systemic disorders occur that may interfere with acid-base balance.

Can drinking alkaline water help with the balance of acid-base of the body?

Support Acid-base balance and hydration. One study has confirmed the consumption of Alkaline water (AK) water was associated with improved acid-base balance (i.e., an alkalization of the blood and urine) and hydration status when consumed under free-living conditions. In contrast, subjects who consumed the placebo bottled water showed no changes over the same period of time. These results indicate that the habitual consumption of AK water may be a valuable nutritional vector for influencing both acid-base balance and hydration status in healthy adults. [1] This study was done using a mineral dense Alkaline water with an alkalising pH of 10.0.

Antioxidant. Alkaline and electrolysed water have been shown to exert a suppressive effect on free radical levels in living organisms, thereby resulting in disease prevention. Oxidative stress-related diseases such as diabetes, cancer, arteriosclerosis, neurodegenerative diseases, and the side effects of haemodialysis may be helped by the consumption of Alkaline water [2][3]

Acid Reflux. Gastroesophageal reflux disease damage is due to pepsin, which requires acid for its activation. Pepsin is the gastric enzyme in the stomach that breaks down proteins in food. Alkaline water with a pH 8.8 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. [4]

Blood Viscosity. Dehydration can seriously impair human physical performance, and can produce effects such as cardiovascular strain, heat strain, altered neurologic function and altered metabolic function. Which has led to research into suitable fluid replacement options for athletes.

A significant difference in whole blood viscosity was detected in this study when assessing a high-pH, electrolyte water versus an acceptable standard purified water during the recovery phase following strenuous exercise-induced dehydration. [5]

Negative side effects

Too much is not a good thing as it could cause alkalosis – a potential life-threatening condition. 
Symptoms include:

• nausea
• vomiting
• hand tremors
• muscle twitching
• tingling in the extremities or face
• confusion [6]

Conclusion

Unless you have certain conditions such as kidney or respiratory disease, your body maintains a healthy pH balance on its own although there are studies suggesting that the consumption of alkaline water may offer health benefits.

References

1. Whitney, Eleanor Noss; Cataldo, Corinne Balog; Rolfes, Sharon Rady; 2002, Understanding Normal and Clinical Nutrition 6th Edition, Wadsworth/Thompsons Learning, Australia
2. Acid-Base Homeostasis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670772/
3. Disorders of Acid-Base Balance: New Perspectives https://www.karger.com/Article/FullText/453028
4. [1] Acid-base balance and hydration status following consumption of mineral-based alkaline bottled water https://jissn.biomedcentral.com/articles/10.1186/1550-2783-7-29
5. https://acutecaretesting.org/en/articles/an-introduction-to-acidbase-balance-in-health-and-disease
6. [2] Alkaline Water and Longevity: A Murine Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906185/
7. [3] Advanced research on the health benefit of reduced water https://www.sciencedirect.com/science/article/pii/S0924224411002408
8. [4]Potential benefits of pH 8.8 alkaline drinking water as an adjunct in the treatment of reflux disease. https://www.ncbi.nlm.nih.gov/pubmed/22844861
9. [5]  Effect of electrolyzed high-pH alkaline water on blood viscosity in healthy adults https://jissn.biomedcentral.com/articles/10.1186/s12970-016-0153-8
10. [6] https://www.healthline.com/health/food-nutrition/alkaline-water-benefits-risks#risk-factors