Alkaline water - hoax, real or both?

The latest health craze sweeping the internet concerns alkaline water. Proponents claim that our terrible modern diets raise the acidic levels of our bodies causing acidosis. These low levels of chronic acidity then contribute to bone loss, obesity, arthritis and other conditions of aging. Like any good fad, they have lots of anecdotal success stories and bizarre pseudo-science explanations about how and why it works, but no real studies to confirm it. What makes this fad interesting is a new study that shows how it really can benefit your health and longevity. The fad fans got the science wrong but there may actually be something to it. However, the overpriced alkaline water brands and ridiculously expensive water ionizing machines are still a scam and a huge waste of money. You can achieve the same benefits at home for pennies a day.

Quick pH lesson

The pH scale measures how acidic or basic a substance is. It ranges from 0 to 14 with 0 being extremely acidic, 7 is neutral water, and 14 is incredibly alkaline. We all have enough common understanding of acids to know how destructive a strong acid can be, but a powerful alkaline like sodium hydroxide can dissolve tissue just as easily as hydrochloric acid. It’s why many fear that going overboard with alkaline water can actually cause more problems than it solves. Typical alkaline water brands aim for a pH between 8 and 10 so they aren’t dangerous to tissues, but you definitely shouldn’t down them all day long.

Forget about too much acid

Our blood is naturally alkaline, with a pH level of about 7.4 (remember water is 7). While pH levels can fluctuate a bit, our bodies have terrific feedback systems to help regulate proper pH levels. Whenever you get too much of something in your blood like acids, bases, sodium or potassium, your kidneys excrete it in your urine to rebalance the levels. There is such a thing as acidosis but it’s caused by serious medical problems like untreated diabetes, severe alcoholism, chronically obstructed airways and kidney failure. Real acidosis requires real medical intervention and even the alkaline water fans don’t tout a few sips a day as a way to treat or cure these diseases.

Alkaline water seems to do something

There are a few interesting studies out there that show that alkaline water appears to do something. They don’t really offer a reason why but the new study that I will get into later actually explains the claims these earlier studies found.

The most quoted mouse study looked at 150 mice over a period of 3 years. The mice that were given alkaline water had a longer lifespan compared to the control group that received tap water. Dissection and analysis of their kidneys, intestines, hearts, livers, and brains found no difference between the groups so the researchers didn’t really have any conclusions on the lifespan differences.

One human study showed that consuming alkaline water for 4 weeks led to improved hydration levels over placebo.

Another study of athletes found that drinking alkaline water after an intense dehyrating workout significantly reduced blood viscosity. The study used this as a biomarker to show improved rehydration and reduced blood flow resistance throughout the body. The only minor detail was that this isn’t a universally agreed upon biomarker and the study was funded by Essentia, a maker of one of the higher priced brands of alkaline water (around 30 dollars a bottle).

I’ve also seen many claims that alkaline water helps with arthritis. I can’t link to any studies because there aren’t any, but I mention it here because the new study that I will get into below does focus on how an alkaline solution can help reduce arthritis symptoms and damage.

It’s not doing what you think

One consistent truth about people is we want answers. We hate mysteries and want explanations. Unfortunately, in the absence of real answers, we tend to make them up. That’s how the theories on alkaline water came to be. We saw possible benefits, did some quick math on pouring a base into an acid to neutralize it and a new theory was born. The problem is that we are not big glasses filled with acid. Human metabolism is unbelievably complex and to assume a simple base could cause profound chemical changes is a big leap in logic.

In fact, most benefits in humans aren’t direct changes, but indirect activations of complex pathways. I’ve recommended many beneficial supplements and nutrients like sulforaphane and curcumin. They both provide tremendous health benefits, but it’s not because of the compounds themselves, but because of the pathways they activate in your body. Sulforaphane is a perfect example because it’s actually a natural insecticide that cruciferous vegetables evolved to protect themselves. We then evolved detoxifying pathways to neutralize it. Thousands of years later, when we eat this insecticide, it triggers so many secondary benefits that it’s ultimately a net positive.

It turns out that consuming a base can trigger a bizarre series of pathways that result in the net positives we see with alkaline water. The new study I keep mentioning showed how a teaspoon of baking soda (sodium bicarbonate) in a liter of water can trigger pathways that reduce inflammation throughout the body.

Reducing inflammation, not acidity

Before I get into the details of how it works I want to reiterate that any base will work. Instead of spending hundreds or even thousands of dollars on overpriced, overhyped fad bottles of alkaline water or ionizing machines, you can instead use baking soda or other cheap antacids. The study used sodium bicarbonate because it’s been demonstrated to be safe and effective and has been used in all kinds of antacid products for centuries.

Now, on to the pathways it activates. This is another mouse study primarily but they did repeat the benefits in people (they just didn’t do the dissections on them). For years, people dismissed alkaline water because it is quickly neutralized by the acids in the stomach. The current mouse study also observed this. The stomach then increases the amount of acid to prepare for the next meal. At this point it looks like alkaline water (or baking soda) is a bust, but the researchers found an interesting pathway activation by observing the mesothelial cells covering the spleen.

Mesothelial cells line our organs and internal cavities like the one that holds your digestive tract. The primary role of these cells is to provide a protective layer that prevents your organs from sticking to each other, but they are also neuron-like and serve important signaling roles. One such role is to detect any potential invaders with tiny hair-like microvilli and warn the organs they cover if an immune response is needed.

The researchers found that the increased acid production from the sodium bicarbonate signaled to the mesothelial cells on the spleen that a lessoned immune response was required. Food is the biggest path of invading organisms into your body, so every time you eat, you trigger an immune response. The spleen stores macrophages (a type of white blood cell) and the researchers found that drinking alkaline water for two weeks changed the composition of white blood cells in the spleen, blood, and kidneys from the M1 variety (which promotes inflammation) to the M2 type (which reduces it). They also saw an increased production of regulatory T cells, which down regulate the immune response and prevents the immune system from attacking your own tissues.

While they repeated the benefits in humans, they used the mice to confirm that the source of this pathway comes from the spleen. Removing the spleen prevented all anti-inflammatory benefits from the alkaline mix. Even moving the spleen was enough to damage the delicate mesothelial connections and stop the anti-inflammatory adaptations. They also severed the vagal nerve that intersects with the spleen to see if this important parasympathetic system nerve had any part in the signaling. While even touching the spleen caused disruptions, severing the vagal nerve had no impact.

We’re too complex to guess

It’s another interesting display of the complexities of our anatomy. Some of the functions of the mesothelial cells were only discovered in the past decade. We often don’t even know what to look at in order to observe important interactions triggered by the foods we eat. I can understand why everyone wrote off alkaline water as a hoax. The science was nonsensical because no one knew what they should even be looking for. Still, anecdotal evidence saw benefits that we can now understand. An overall reduction in inflammation will reduce heart disease and cancer risk. It will also improve longevity and lifespans (like what was shown in the first mouse study). The researchers of this particular study concluded that a teaspoon of baking soda mixed in a liter of water could help reduce the symptoms of autoimmune diseases like rheumatoid arthritis. Reduced inflammation will also prevent bone loss, but not because of acidity eating up calcium. In fact, another mouse study showed that obesity from a western diet causes harmful species of bacteria to flourish. These pro-inflammatory bacteria then trigger rapid degradation on the bones and cartilage throughout the body. Simply adding the prebiotic oligofructose to their diets helped beneficial bacteria establish a foothold in their microbiomes which reduced inflammation. It didn’t result in weight loss but it reduced diabetic symptoms from the terrible diet and immediately stopped bone and cartilage loss.

Don’t buy “official” alkaline water

A standard high-fiber, low-sugar diet will also help reduce inflammation, but for those considering trying the benefits of alkaline water, just do the baking soda. Be sure to limit it to one teaspoon a day. Acidosis is a real condition, but so is alkalosis. You can cause a whole new set of problems with too much sodium bicarbonate, so don’t assume that more is better. At the very least, please do not support overpriced fad products. All they do is add confusing pseudo-science to the already confusing health and nutrition space, so that they can separate you from your money. The more stupid claims snake oil salesmen make, the less likely you are to listen to the next bit of real fitness news that can truly help you out.