Alkaline water
March 11, 2024

Does Alkaline Water Help Acid Reflux?

Alkaline water


  • When you have reflux, acid, and a nasty stomach enzyme, Pepsin , comes up and pepsin sticks wherever it lands, e.g., your throat, vocal cords, sinuses.
  • It’s pepsin (not acid) that causes respiratory reflux disease, i.e., swelling, inflammation, and tissue damage… however … pepsin needs acid to activate it.
  • Thankfully, there’s a nice physiologic twist: The pepsin molecule dies in an alkaline environment (pH >8). Thus, the antireflux treatment program that I recommend uses an alkaline diet with lots of alkaline water … to help eliminate pepsin.
  • I suggest that you get water pH 9.5 without phosphates. You can use it three ways; (1) Drink it (2) Spray it in your throat, or (3) For pH balancing, i.e., neutralizing acid in other foods and beverages you consume.
  • Alkaline water has no side effects. People who say otherwise online are just wrong; alkaline water never causes any symptoms; it’s just water.

What Is Alkaline Water?

You may be surprised to know that there is a massive amount of water underground. Most of it occupies spaces between rocks; and although unseen, underground water contributes to the formation of major rivers and streams. 

As underground water moves through caverns and streams, it picks up calcium carbonate from rock, particularly limestone, which makes alkaline water alkaline. It is worth noting that alkaline water naturally occurs; it needn’t be manufactured.

What does alkaline mean? It has to do with hydrogen ions, which are measured using the pH (potential of hydrogen) scale. This scale tells how acidic or alkaline a substance is. The pH scale ranges from 0 to 14. A pH of 7 is neutral, less than 7 is acidic, and greater than 7 is alkaline.

Examples of the pH of things may help. Stomach acid is pH 0-4; and believe it or not, most soft drinks are also in that same pH range. Most city (tap) drinking water is pH 7, and alkaline water is usually between pH 8.8-10.5. Most foods, especially fruits, and vegetables, are on the acidic side, but milk (cow, almond, soy, etc.) is alkaline (~pH 7.4) … but not nearly as alkaline as alkaline water. 

Alkaline water is the most abundant and most alkaline substance in the world, and thank goodness, because it’s great for acid reflux. It neutralizes acids and helps heal tissue that has been injured by pepsin. Alkaline water is helpful in at least three ways for people with acid reflux.

Is Alkaline Water Safe? Yes, it’s safe as could be. Alkaline water does not cause any symptoms or adverse effects, period. That said, I do not recommend (manmade) alkaline waters that contain phosphates like Essentia. Phosphates are not good for people on dialysis or have severe kidney disease; and most alkaline waters are phosphate-free.

Can Alkaline Water Help Get Rid of Pepsin?

When you have a reflux event, acid and Pepsin, a nasty stomach enzyme, come up. Pepsin sticks and stays where it lands, in your throat, sinuses, vocal cords, etc. It is on the surface of tissues, but it also embeds itself inside. And it is pepsin (not acid) that causes swelling, inflammation, and/or tissue damage … and causes most reflux-caused respiratory tract diseases. However, pepsin must be activated by acid.

The left biopsy of a reflux laryngitis case has a conventional H&E stain, and the right, from the same biopsy, is stained for pepsin. The pepsin is on the surface of the tissue, causing ulceration, and embedded deep in the tissue. 

If you have voice changes — raspiness, heaviness, lower pitch than normal, and loss of pitch range — and respiratory reflux, your vocal cords look something like those above. but maybe not that severe. Indeed, most people with Silent Nocturnal Respiratory Reflux have swollen, pepsin-laden vocal cords.

But here’s a good-to-know physiologic twist: Although pepsin requires acid for activation, it cannot survive in an alkaline environment. Pepsin is denatured, falls apart, and dies at pH >8. Therefore, alkaline water is of great benefit for people with respiratory reflux in different ways, most related to killing or washing out pepsin.

At the cellular level, tissue-bound pepsin is fundamental to the pathophysiologic sequelae of respiratory reflux, and pepsin remains stable at pH 7.4. Thus, most tap and bottled waters (typically pH 6.7 to 7.4) would not be expected to affect pepsin. 

In 2012, studies in my laboratory were performed to determine whether pepsin was inactivated by pH 8.8 alkaline water. Indeed, pH 8.8 instantly denatures pepsin, rendering it permanently inactive. BTW, this publication started the alkaline water craze.

So, Should I Use Alkaline Water? Yes! You can drink alkaline water, spray it into your throat, or use it for pH-balancing. The latter? Alkaline water can neutralize acidic foods and beverages, helping to counteract their potential negative effects. That said, today, I recommend alkaline water ~ pH 9.5 for my patients. 

Should I Spray Alkaline Water Into My Throat? Yes!

When you swallow (anything), the lower throat closes as tight as a fist, so you do not aspirate into your lungs. So, if you drink alkaline water, none gets into your voice box or vocal cords. But you can take your pH 9.5 water, put it in a spray bottle, and spray it onto the vocal cords.

Here’s a link to this Bottle. I also personally use a Cerra Water Pitcher for my alkaline water. I love it, but don’t put it in the dishwasher; it will melt.

I’ve treated an awful lot of singers, actors, teachers, clergy, and salespersons. Actually, 80% of us are professional voice users. If your vocal cords are swollen from long-standing Silent Nocturnal Respiratory Reflux, your voice will probably be husky, and you’ll experience vocal fatigue and effort with prolonged conversation.

Alkaline water throat spray is a great way to provide anti-reflux vocal hygiene. Many Broadway performers carry those little blue bottles at all times.

 How Do I Use Alkaline Water For pH-Balancing? 

If you took equal amounts of opposite pH acid and alkaline water and mixed them, the pH would probably be about 7, neutral. The concept of pH balancing follows that line of thinking; however, sometimes the acid is consumed first and then followed by alkaline water. 

You just finished enjoying a salad with balsamic vinaigrette dressing. This dressing is acidic and might worsen your reflux. However, if you drink alkaline water afterward, it may balance out the effects of the small amount of acid in the vinegar. Remember that this method may not work if you consume a large amount of acid, such as drinking a 16-ounce Coca-Cola.

I have previously posted how to make pH-balanced smoothies … starting with pH 9.5 ice cubes (tray), a banana, and almond milk. After that, you can add almost any other ingredients (except green apples and citrus) and still have a smoothie that has an acceptable pH of 5.5 or more.

Pearl of the Week

When I first recommended alkaline water to refluxers, I was concerned it might affect kidney stone formation. Eureka! An alkaline diet with lots of alkaline water helps prevent kidney stones. However, alkaline waters containing phosphates, e.g., Essentia, are not good for people on dialysis.


If you’re interested in scheduling a virtual consultation with me, you can Book Online. Additionally, if you’re looking for more information regarding the diagnosis and treatment of respiratory reflux, I recommend checking out my two companion books on Amazon: Dropping Acid: The Reflux Diet Cookbook & Cure and Dr. Koufman’s Acid Reflux Diet. For those who suffer from chronic cough, I suggest taking a look at The Chronic Cough Enigma.

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