Alkaline Water for Reflux: Why, Which, and When?

Bottles

What is alkaline water? Alkaline is the opposite of acid. It is sometimes also called “basic.” The way we measure acid is by the pH scale, and this scale can be confusing. pH 7 is neutral, that is, it is neither acidic nor alkaline. Acids are below pH 7, and bases are above pH 7. The lower the number, the more acidic. pH 2 is more acidic than pH 3 and the difference is tenfold. For example, pH 2 is 10 times more acidic than pH 3 and 100 times more acidic than pH 4. (The pH scale is logarithmic like the Richter scale for earthquakes, but in reverse. With the pH scale, lower numbers are more acidic (worse), but with earthquakes, higher numbers are worse.) The commonly available alkaline waters that have the most benefit for refluxers have pH values of 8.0-10.5.

Why alkaline water? Stomach acid is pH 2-4; and by the way, and so are most soft drinks. My first book on reflux, Dropping Acid: The Reflux Diet Cookbook & Cure, focused on the fact that for refluxers, an acidic diet is damaging to the throat and the esophagus. See also our newest book, Acid Reflux in Children: How Healthy Eating Can Fix Your Child’s Asthma, Allergies, Nasal Congestion, Cough & Croup. Kids have the same reflux problems and alkaline water helps them, too.

It is amazing that almost everything in a bottle or can except for still water has the same acidity as stomach acid. The explanation for this has to do with the FDA; in 1973 following an outbreak of food poisoning, the FDA mandated acidification of everything in a bottle or can crossing state lines in order to kill bacteria. They never dreamed that manufacturers would add so much acid to their products. I recommend that people with reflux just drink water, especially alkaline water. (If some kind of milk is needed, too, I suggest almond milk as the best choice.)

The cell biology of reflux explains how reflux damages tissue to cause swelling, inflammation, and even benign and malignant growths. While tissue damage does have something to do with acid, it is the main enzyme of the stomach, pepsin, that is the really bad actor. When you have reflux, pepsin that comes up attaches itself to the tissues of your nose, throat, vocal cords, esophagus, or wherever it lands. In a research paper, we biopsied the throats of people with reflux laryngitis and found tissue-bound pepsin in almost every case. So, here’s the catch, while pepsin does the most damage, it does require acid for its activation. Conversely, pepsin is inactivated — the molecule dies — when it is in contact with pH >8.

In comes alkaline water. In 2012, we published a paper entitled Potential Benefits of pH 8.8 Alkaline Drinking Water as an Adjunct in the Treatment of Reflux Disease. The paper 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 was that paper started the alkaline water craze.

What does it all mean? Alkaline water is good for reflux as it helps wash out that nasty pepsin enzyme. Furthermore, it helps balance the pH of other consumed foods that may be somewhat acidic. Yes, I recommend alkaline water for all of my patients with acid reflux, especially those with respiratory reflux.

Which alkaline water? Some alkaline waters are manufactured (by adding chemicals to regular water), and others are naturally occurring, that is, they come out of the ground that way.  Given a choice, I recommend naturally occurring alkaline waters over the manufactured ones. In addition, I recommend waters that are bottled in BPA-free plastic. There is one notable exception, cerrawater.com. The Cerra Water Company makes a pitcher that looks like an ordinary water filter pitcher; however, it makes pH 9.5 water out of tap water, day in and day out. I personally use this, and it keeps me from having to cart heavy bottles of water from the store.

The measurements shown below as “Actual pH,” I performed with an Apera SX610 pH tester. I have ranked the products by pH with the highest pH. In addition, I have indicated which test waters are natural and which are manufactured; I believe that the natural waters are preferable. For an alkaline water to be effective for reflux, its pH should be 8.0 or higher.

Product Natural pH Claim Actual BPA-Free
         
Trader Joe’s Alkaline Water No 9.5 9.8 No
Alkalife TEN Yes 10 9.6 Yes
Essentia No 9.5 9.5 Yes
Aqua Hydrate No 9.1 9.4 Yes
CerraWater No 9.4 No
Nice Iceland Pure Yes 8.88 8.8 No
Evamor Yes 8.8-9.1 8.8 Yes
Iceland Spring Yes 8.88 8.8 No
Islandic Glacial Yes 8.4 8.4 No
Eternal Water Yes 7.8-8.2 7.8 Yes
Bai No 7.5 7.8 No
Nice Spring Water Yes 7.7 No
Fiji Yes 7.7 7.2 Yes
Core No 7.4 7.4 Yes
Evian Yes 7.3 No
Delish Electorlyte Water No 7.3 No
Life WTR No 7.1 No
New York City tap water No 7.1
Nestle Pure Life No 7.0 No
Deer Park Yes 6.5 No
Poland Springs Yes 6.5 No
Aquafina No 5.9 No

When? Alkaline water can be consumed when ever you want. There is no downside, that is, you cannot drink too much alkaline water. It should be used for reflux in the acute phase, especially if you have hoarseness and/or other throat symptoms. Drink alkaline water with your meals and particularly as a “chaser” after any food that is acidic. Such include most fruits (except melons and bananas), tomatoes, spicy foods, and sauces. You do not have to carry your alkaline water into a restaurant; you can drink regular tap water too; but when convenient, drinking alkaline water most of the time is good for you.

Note: I am keeping the bottles of alkaline water tested for several months so see if the pH falls over time; this will be published in the future as a second blog on the shelf-life of alkaline water.

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