Let’s start with the basics of alkaline water and acid reflux (this is a pun, which you’ll soon learn).
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, neither acidic nor alkaline.
Acids are below pH 7 (the lower the number, the more acidic), and bases are above pH 7 (the higher the number, the more alkaline).
pH 2 is ten times more acidic than pH 3 and pH 2 is 100 times more acidic than pH 4. So these numbers are pretty significant.
The commonly available alkaline waters that have the most benefit for refluxers have pH values of 8.0-10.5.
A quick video, then lots of details.
Why alkaline water for acid reflux?
Stomach acid is pH 2-4, as are most soft drinks.
One entirely true but amazing fact is that in America, almost everything in a bottle or can except for still water has the same acidity as stomach acid.
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. I don’t think they ever dreamed manufacturers would add so much acid to their products.
As a result, I recommend that people with reflux just drink water, especially alkaline water. (If some kind of milk is needed, I suggest almond milk as the best choice.)
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. If you aren’t aware of the impact acidic food and drink has on reflux, take some time to understand that. It’s extremely important.
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 comes up from the stomach and 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.” 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 and Barrett’s.
Which alkaline water for acid reflux?
Some alkaline waters are manufactured (by adding chemicals to regular water), and others are naturally occurring (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. I like this bottled water you can grab off Amazon.
A Canadian company, Cerra Water, which makes a pitcher that looks like an ordinary water filter pitcher that makes pH 9.4 water out of tap water, day in and day out. Or if you like to buy off Amazon, this pitcher is also great.
I personally recommend and use this Cerra Water pitcher, and it keeps me from having to cart heavy bottles of water from the store.
However, if you would prefer to buy bottled alkaline water instead of the Cerra Water pitcher, I tested common alkaline waters on the market and showed the “Actual pH” measured by pH paper.
I have ranked the products by highest actual pH to lowest, adding in which are natural and which are manufactured. I believe that the natural waters are preferable.
Remember: for an alkaline water to be effective for reflux, its pH should be 8.0 or higher, so anything below that threshold is crossed out because it’s unhelpful.
pH (tested by me)
Trader Joe’s Alkaline Water
Nice Iceland Pure
Nice Spring Water
Delish Electrolyte Water
New York City tap water
Nestle Pure Life
When should you drink alkaline water for acid reflux?
Alkaline water can be consumed whenever 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.
That includes most fruits (except melons and bananas), tomatoes, spicy foods, and sauces. You can drink regular tap water too, but drink alkaline water as much as it’s convenient.
For You Refluxers: The Key Rules of Controlling Reflux Apply
- Don’t take PPIs!
- Understand that acid reflux increases your risk of esophageal cancer, so get screened
Reflux is curable with effort and commitment to change.
However, here are the most important pieces of advice I can offer:
- No eating or drinking within five hours of going to bed
- Sleep on an incline no less than 45-degrees (gravity helps)
- Eat five small meals
- No fried or high-fat foods
- No alcohol, chocolate or soft drinks (including fruit juice) of any kind
- Take Pepcid 20 mg. before each meal and before bed
- Take a tablespoon of Gaviscon Advance Aniseed after each meal and before bed (not available in stores in the U.S., but available online)
- Drink alkaline water as much as you conveniently can: an alkaline pitcher is convenient (and test it with pH paper or a pH tester to make sure it's 8.0 or greater)
If you've read at least one of my books and you're following this guidance and you still need help, you can book a consultation with me.
P.S. - Why Doesn’t My Doctor Know About This?
I get asked this all the time: “Why doesn’t my doctor know about this?!”
My primary research on acid reflux and chronic cough has been available for decades. Dropping Acid has been a best-seller for a decade. And I was on TV and quoted in mainstream media for many years. But the medical community remains virtually unaware that LPR (laryngopharyngeal reflux), today often called silent reflux or respiratory reflux (all terms I coined), is a major cause of respiratory issues and chronic cough. In addition, neurogenic cough seems almost never properly diagnosed.
Thousands of my patients have been on a merry-go-round of specialists… a GI doctor, an ENT, an allergist, an asthma specialist. They’ve had tens of thousands of dollars of tests, prescriptions for medications that never could have helped them, and their respiratory issues never improved.
The problem in the U.S. is over-specialization. Most Americans mistakenly believe that they must see specialists for almost every medical problem. What people don’t know is that specialists determine what services insurance will pay the most for, and they can choose to deliver those expensive services… even for patients who don’t need them! The idea of dividing the body up into small, non-overlapping, anatomic areas makes no sense. The respiratory and digestive systems are intimately connected, and specialists do not seem to know that.
Imagine building a house by allowing each workman to do his own thing. The plumber would put a sink in every room. The electrician would install chandeliers on every ceiling. The carpenter would panel every room in luxurious wood. That’s how America’s medical specialist system works.
The evolution of my personal medical practice as an expert in acid reflux that affects the throat and airway (LPR, silent reflux, respiratory reflux - all terms that I coined) helped me see that silent respiratory reflux was ubiquitous. That means it’s all over the place, and it’s likely in almost half of Americans. REFLUX is the single most common cause of “allergies,” “asthma,” “sinus disease,” true sleep apnea, and chronic cough.
Please read up and advocate for yourself, finding solutions that may be elusive through traditional care channels.