72. Progress Note #3: Alkaline Water & Diets - Worth the Hype?

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Welcome to an episode of the Progress Note. In Medicine, the Progress Note is a medical record that documents a patient's clinical status or achievements during their care. It typically consists of four components. The subject of data, the objective data, the assessment, and lastly the plan. It essentially is a systematic review in a point of time. Other goals with these episodes are to highlight mainstream practices, take a deeper dive, and approach polarized topics with nuance. While advancement is always happening in medicine, rethinking data as well as our beliefs is a rare occurrence. Join us as we continue to make progress, hold ourselves accountable, and redefine medicine. Alright, welcome back everyone to another Progress Note. This will be number three. Ultimation Eye is going to be talking all about alkaline diets and alkaline water and what it means to be alkaline. Ultimation, what are your takes? Hmm, I have quite a few, but before we get started, I must know why are we even talking about this? What was the inspiration? I think that's important to kind of set the stage a little bit. Sure, absolutely, so there's kind of three instances that I can come up with where I've heard about alkaline and actually kind of wanted to look more into it. So the first is, probably about two to three years ago when I'm going to 7-11 or Wawa and just trying to get water, you start to see these brands pop up that say, hey, try this alkaline water, be more hydrated. So interesting, you say, okay, what does that mean? The second instance is, I remember my mother-in-law actually, through WhatsApp, sending me like a link saying, hey, should I buy this water filter? And alkalinizes, I can't even say that word, your water. And obviously, there's been a big push, people are more health conscious in terms of the water they're drinking, you know, burky filters, reverse osmosis. But now there's this whole branch of water filters that are alkaline. And then the third is, for people who really know me, I'm despised, Tom Brady. And so he's known to push his TB12 plan, right, his workout, his diet. And what are the main components of his diet, aside from being like no-night shades and anti-inflammatory, is an alkaline diet. And I had a call BS, I thought I was like, this is an alkaline gait with a deflate gait with all the other gaits he's had. And so I was like, we got to do an episode on this. God, he sounded like such a hater. Yeah, yeah. I'm with it though. You know, it's interesting, because this thing, it's kind of like weaves in and out of mainstream health and wellness space. And I guess it's just one of those things, as more and more people come into it, maybe this is something that's just such a basic thing, no pun intended, in our lives, that we, you know, you tend to be like, okay, how can I optimize my water? And listen, we're partly guilty of this, because we've had an episode discussing how to exactly optimize our water, shout out Tracy Dews, who actually I think did talk about this on hers. So we'll try to find that and link it as well. But I think, when I think about how this nonsensical fat kind of even started, it, it, it prays upon some of the terminology, right? And the video that you sent me, this one YouTube video, which I think this guy does a great job. Maybe we can find that as well, that they use a terminology that acids, right, acids are, are bad for you. And acids have a negative charge, right? So this is going back to our chemistry and, and the negativity cannot be good for your body and basis are, are positive, and, you know, for those, getting into chemistry here, and so the positive sign, therefore, must be good. And then you have some really well-known celebrities who, who back it up, and they kind of say, oh, you have all these benefits. What's interesting, I saw, I think it was a meme or somewhere in Instagram that there was a celebrity person who actually sells a lot and she, like, puts lemon in her, you know, alkaline water, which is like, what are we, what the hell, and those who understand that, you know, lemon is more of an acidic thing and you're completely offsetting it. Right. And so all that being said, and I think from scientific perspective, there is a little bit premise, right? I think that alkaline diets, kind of what you're looting to, they have shown to have some benefit for very specific ailments, right? And so naturally people think, okay, well, if it works for one thing, it must work for other things, not understanding pathophysiology and how it can be grossly different when you go from one disease to another disease state. And I think lastly, people will say a lot of the western diet, the center of American diet, particularly contains high amount of acidic foods, right? Common ones that come to mind is we have a lot of like meat products and whatnot, a lot of coffee myself included guilty of that. And so to counteract that, of course, we need to put more alkalotic foods or basic foods into our body. And so I think from that aspect, I do get it. But it's just a very poor understanding that just because you're ingesting in how the body process it might be completely different, not to mention how every single organ has their own and the blood has its own stuff that we're going to talk about. But I think that's my takeaway of why the hell we're even in this mess and why we're here talking about it. Absolutely. All right. So let's break it down, right? So when we say alkaline, ultimately, I think you did a great job talking about basics and positive, right? The cations. So pH is on a spectrum, right? And so seven is neutral. Anything below seven would be acidic and anything above seven would be basic or alkaline. So in order to go above seven, you need to add minerals such as magnesium, calcium, sodium, potassium, right? These are things we're going to be talking about. And because those have a positive charge, you're going to increase that pH. So there's a difference between becoming alkaline, like your body actually becoming alkaline versus ingesting alkaline water or alkaline food, right? I think that's where the marketing likes to trip people up is that, hey, this is alkaline and people think, oh, I'm going to make my body alkaline. But we know that's not true, given that the human body would probably die if it just all of a sudden became more alkaline, right? Like our pH is very tightly regulated. And you just talked about this, how different organs, such as our stomach, will actually be more an acidic pH, right? So it can break down foods. But you know, you've done your ICU time, like we rage at what human bodies like a 7.4. And even if you go like 0.2, you're like in danger zone, right? I mean, you can touch on that. Yeah, absolutely. I think for those who don't know, 7.4 is kind of the ballpark, you know, a normal pH, what we learned in medical schools, anywhere from 735 to 7.45, and so 7.4 for ease. But yeah, in the acute state, if somebody goes down to 7.17.2, that's an admission to the ICU. You buy yourself a bed there. You know, with chronic disease states, you know, like diabetes or chronic, like obstructive pulmonary disease, your baseline pH is altered a little bit, just because the way that you have, you know, gas exchange in your body and the way that your kidneys are functioning, that is, that's going to be developed over time. So you might be more alkalitic. You might be living at a 7.6 or you might be living at a 7.3. But again, that takes a long, long time and people are generally have some type of chronic illness. So again, that's not anything to strive for. And it's certainly nothing that you're going to correct by ingesting with a little bit of alkaline water. And I think what's important to note, really, really important to note is because of, because like acute changes can put you in the ICU, the bodies, the kidneys and lungs in particular, do an extraordinary job, making sure that you're staying in this narrow window, right? And then to your point about, okay, just because you're ingesting something doesn't mean that that's going to be metabolized in such a way that it's going to make your, your blood pH. That's another important point that I think we need to make is when we're talking about this number 7.4, that's referring to our blood pH, right? And we can actually measure that. You can get a venous gas where we draw it from your veins or an arterial blood gas where we typically do it from a radial artery or a femoral artery or something like that, typically radial. And we can really get the pH. But every single organ has their own specific pH, right? Make the stomach, for instance, where most of the things have your first pass, that is a pH of about two. So if you're going to put a slightly more alkalotic or basic water inside, when it's get to an environment where the pH is two, what do we think is going to happen? Is it just directly going, unless we're putting IV, alkaline water, I'm not sure. I imagine somebody is doing that after it, you know, hopefully nobody listened to that and that's going to be my hack to that. But I'm willing to bet that there's some crazy person out there who's figured this out. And so, you know, I think that's failure number one. To really understand that just because, you know, you're putting something in your body, it's going, you're going to get exactly, it's like a one-to-one, right? And we know that's not the case because there's a multi-step process, in fact there's hundreds and thousands of enzymatic processes that are happening that, you know, what you're putting in your body doesn't ultimately come out to be absorbed and ultimately excreted from your body. Absolutely. Cool. So, I kind of want to delve into the research, right, because I don't think we can have this talk without backing it up. And so, you know, I'll link the paper to our show notes, but what are the claims, right, is that alkaline water hydrates you more. That's just what the marketers like to say, which is why they're selling in the convenience stores. And that could be true. That's just not true. If you look at actual urine samples, yes, you'll see like higher cations, like we mentioned, like urinary magnesium, urinary calcium, all these things in your urine. And again, you probably have to be drinking a lot of alkaline water for that to show up, but no, it does not necessarily hydrate you more. The other things that I found really interesting were, so when we talk about diet now, alkaline diet, a lot of this just means fruits and veggies, right, because these are the things that are going to be holding those minerals, right? minerals is the key word, which everyone's called, mineral deficiencies, yeah, absolutely. So back in the day, when we had better soil, there would be, we would measure the ratio of potassium to sodium, right? So everything in our body likes kind of ratios, right, like our salt, for instance, our sodium in our body is in a ratio with the water. So the same thing is with potassium and sodium, especially with intracellular processes. So the ratio back in the day used to be like a 10 to 1 potassium to sodium. And now it's actually full, it's one to three. So most of our foods are actually having more sodium than potassium. So even though we think we might be eating that alkaline diet, we're not eating as if it were 50 years ago. And it's crazy. I actually, I don't know if this is true. I heard this anecdote, but like eating one apple in the 1950s to get that much nutritious value, you would have to eat like 10 of those apples today. Like that's how much our soil just has been depleted over time from proper nutrients. So that was one of the things they talked about. Go ahead. No, I was going to say, yeah, that's exactly what the proponents are regenerative farming talk about. Or regenerative agriculture, right? That's how critical that is because you have this dead soil and they're not nutritious. So when you're growing these crops, you know, it's become a real issue and like, you know, I've been listening to a lot about a lot of folks recently talking about monocroping and how that's killing us and the reasons to eat one way versus another. But yeah, sorry, that's a different day, a different discussion. Yeah. So like, so that point, that that's point number one. So maybe why we should incorporate an alkaline diet. Point number two is that majority of this world, I don't know the exact number. I've heard it's above 70% is magnesium, magnesium deficient. And so trying to get magnesium in will help, I mean, magnesium is in so many different processes and somatic processes that it is, obviously vital, you know, when it comes to sleep, when it comes to your muscle, just so many different things. So including an alkaline diet can help restore that. And then number three, which I found very interesting, which there's actually a lot of papers on is about chemotherapy and eating alkaline. So chemotherapy, right, using these harsh chemicals and harsh drugs sometimes work better in different media and media, meaning the like solution to solving that it needs to be in the buffer. So some chemotherapeutic agents work better in acidic environment, whereas some actually work better in a basic or alkaline environment. And so there's these papers that talk about, hey, if you're taking on these chemo agents, maybe you should be eating like this. Now again, coming back to, does it really change our body and our pH? Not really, but is there some sort of effect that we might be able to see? I don't know. So this is kind of where it gets a little controversial. But those are at least three ways that an alkaline diet can help you in some way according to this paper. The one negative, if I'll just finish right here real quick, one negative is that too much alkaline can cause kidney stones. And this is just well known, right? If you're getting too much calcium, too much of the minerals that can just cause build-up and you can get kidney stones. Yeah. And what's important to note about all the things that you're mentioning, okay, well first off, it's a quick side note. It's interesting how literally everything that we talk about comes back to, hey, if you just eat more fruits and vegetables, then good things are going to happen. It's just, it's so interesting. But you know, so very much so like the alkaline water, again, a lot of them are going to have many of these minerals that added that you reference before, right? So the question that becomes okay, well, is it the higher pH of the solution or is it the actual minerals that are addressing some type of deficiencies that you alluded to, right? Or, you know, are those that are making you feel a better? Like we, again, we talk about magnesium being a therapeutic for so many different ailments, again, from chronic issues like for sleep, chronic insomnia or depression or anxiety and things of that nature, cramping, you know, we often tend to use that as supplement. I do really want to caution here and tell people, you know, just because you threw the stat out there about magnesium, I don't want people to think, well, okay, well, I'm going to start just to supplement with magnesium because, again, like everything else in our body, it's very tightly regulated. And yes, if you're insufficient or deficient, that's going to have problems, you can't overdo it, though. And again, that'll, but that will also buy somebody a ticket to the ICU. So again, we have to be very, very careful and this is why you need to work with a professional way to do this. Anyways, disclaimer aside, so again, going back to just because an alkaline diet, which really is fruits and vegetables, you know, again, it's hard to tease out that whether it's the minerals, the vitamins, the not putting processed foods, which tend to be more acidic, not overdoing it on the protein and the fatty foods and things of that nature, which can be more acidic, not going crazy on the teas and the coffee and things of that nature, which again, in large amounts can be more detrimental and the beneficial, is that what's doing, giving us the benefit, you know, or is it the higher pH value? Yeah. What's really, really challenging to tease out, but it doesn't equate to buying water that is just priced an astronomical amount, right? Like, I don't know, like $3, $4, $5 a bottle when it's just tap water and it's not really shown, it doesn't, we don't have any hard data to prove that it is going to be more beneficial. There is some literature out there. Like, I mean, when you go and do in PubMed Search and I was really, really fascinated to find this out, I mean, there are a lot of people who've actually asked this question and looked at this question in different aspects, right? Whether it's longevity benefits, whether performance benefits, in fact, a study comes to mind published last year, I think it was one of the, like, a journal of human kinetics or something where they looked at 12 individual, 12 healthy college age individuals and they showed that alkaline water versus just regular water tended to improve anaerobic performance, right? And so that was interesting, but again, in that study, if I recall correctly, one, it was only like 12 individuals, but secondly, when they check lactic acid or pH lactate and resting in post-exercise, it really didn't make a difference, right? So when you're checking these blood markers, that's not, but for some reason, it seems to help. Now, that's not new, though, right? Sodium bicarb has been used as an ergogenic aid for decades, right? The problem is people don't tolerate, especially in endurance athletes, like cyclists and stuff like that, people don't tolerate it because it has massive gastrointestinal issues. Again, because you don't want to be just taking baking soda and putting it in water and gesting it, like bad things are probably going to happen. So, you know, there's interesting stuff about their, oh, out there for this, but again, does that mean that we should be paying 3x, 4x, 5x, 10x, whatever, you know, just assing nine prices, people are charging for this? I'm not really sure. I guess the question becomes, is there harm to do things? You talk about the kidney stones, right? That's one. But what's the harm if somebody wants to take alkaline water? I think that's the main thing. It's really the kidney stones. It's really just overdoing it, and you know, I don't think you're going to change your pH, I mean, chronically, maybe, right? There's a lot of talk of people using it for reflux. That's still up in the air. But that's the thing. I don't think there's much harm, right? So, a lot of the videos you watch and things are like, hey, if you want to try it, go ahead and try it, right? So, like, when I break down the data, and I look at this, I'm like, it's all a gray area, right? Like, taking an element, for example, right? I guess you can call that, you know, alkaline. But I'm not going to be taking five packets of element in a day, right? Whereas some people are just drinking alkaline water throughout the whole day. Rather than just one, you know, one eight ounce glass, sure, you might feel a little bit better or something. But that's where I think, you know, people need to dial it back, just because it's good for you once, doesn't mean it's good for you, you know, over and over and over. And for those who don't know, you're referring to a solution, a hydrating solution pattern form, element T, which both of us do like. But yeah, no, I mean, that's the only thing that I can truly think of is the financial harm. I know we talked, we threw out the kidney stones thing there out there. But again, the amount of water, I think people would have to ingest in order to be able to get that. I couldn't even imagine, right? I couldn't even imagine how much water they would have to take to get there. Unless, again, they had some underlying chronic illnesses and stuff and they're more susceptible to this, right? That's a different story. Hard to really know. But then that also begs a question is when they pick up these, these alkaline water solutions, right? They go to like Whole Foods or really whatever. And they're like, okay, our alkaline water. I think most of them will advertise it's going to be anywhere between eight to 10 or eight to 11 in that range, right? Right? Regular water supply. Yeah. The Seven Ball Park. Is it truly that, right? Who's taking like a pH meter out and actually testing that? I listened to a zero-gamety show recently. He was talking about one of the waters on the back. It gives a little disclaimer. It says, oh, you know, you can't really use regular pH strips for that because they're not accurate, blah, blah, blah, blah, blah. You need to check a pH meter. And he's like, okay, well, so that's like, trust this placebo when you get it at 8.5. You know, I just found that to be really fun. So that's the other point. It's like, okay, ever you're going to pay $5 to really know that you're not maybe getting what you think you might be getting, which might not even be beneficial at all. I don't know. That might even be spent elsewhere. Yeah. Like buying five out of a covacados or something, you know? Absolutely, man. And I think the biggest takeaway for me, right? Like when it comes to our assessment portion here is that it comes out an alkaline diet's eating fruits and veggies. Like, imagine if I just had eat fruits and veggies versus I'm saying eat alkaline. Like, you know, it's that buzzword that people are like, oh, yeah, I got to do that. Like if that's what it takes to get people to eat fruits and veggies, but it's nothing new, right? Like it's not anything new. It's just people rebranding it, taking a sexy word and marketing it. Yeah, it's funny to me. So what's your plan? What are you after this discussion? What do you want the audience to know that you're going to be doing? You know, I think nothing new, same old message, but you know, repetitionism or the mother learning they say at least. And so just get more fruits and vegetables, like all the more recent. It did give me, you know, when I was doing research for this, it did make me reconsider because I do eat a lot of acidic foods, right? And I was like, okay, well, it's interesting. Some of the foods that I didn't even know have a higher acidic values. When you look at on the pH scale, particularly a lot, we know that a lot of different meats do coffee, of course does. We know that my coffee consumption needs to definitely be dialed back, which I'm actively working on, a little bit challenging. So it made me reconsider, okay, maybe I need to offset, right? Again, this goes back to our very first PN when we talk about, you know, meat and cancer, all that stuff is that the studies will report that if you, you know, eat an equal amount of vegetables, it can potentially offset some of the carcinogenic, carcinogenic, you know, effects that it might have, right? Process meats. And so that holds true here as well, right? And so it can offset some of the acidic properties of meat. There is something that I actually learned about. It's called the PRAL. It's the, what's it called? It's the, oh, potential renal acid load. Every single food has that, right? And this is essentially what we talked about at the outset is just because you're ingesting a food the way that your body processes it might be completely different in terms of the acid load it's going to have, right? So in terms of what the final pH after some metabolize on your kidneys, that effect is going to be. And so interestingly, every single food that's out there according to, you know, United States Department of Agriculture has a PRAL or, you know, potential renal acid load. You can google a chart on this if you want, you know, I mean, there's a million different variations of that out there to get a sense of, okay, you know, what kind of, what are my routine, you know, mainstays a part of my diet and it's my potential renal acid load really high. And you, wait, again, what you'll note though, I'll give you a quick cheat sheet is if you eat more vegetables, it's going to be low, you know, if you eat less vegetables, then it's going to be really high because everything else is going to be high. So, so again, going back to balance pendulum coming back to the middle. I think that's the name of the game. Absolutely, man. Yep. So my three big takeaways from here is one, I'm not going to go out of my way to buy alkaline water. I'm not going to go out of my way to make my water more alkaline or get a filter to I'm already already eating an alkaline diet, right? If I have a salad a day, I'm getting more fruits and veggies. That's that's going to be taking care of my mineral consumption, you know, of course, I'll add in some element packets, you know, if I'm doing some cardio or something. And the third thing is like, I'm not going to avoid acidic, right? Because like if I'm just saying, hey, I'm not going to have any acidic foods, well, there goes the protein, right? Which we just talked about. And we know that acidic foods that contain protein can help you with muscle building, which will help you with longevity, right? So everything comes down to a balance. And so I'm definitely not a fan of, you know, living my life just in terms of one way or the other. So that's why I'm not a big fan of this whole alkaline bed. Yep. But listen, if somebody tells me that I want to get it because I love the taste of it and it makes them feel good, then, and I've got lots of extra money to spare, then I would say, by all means, go for it. And you can donate to my student loan charity as well. Not kidding. That's right. But hopefully, guys, that was helpful. You know, if anybody has any thoughts or any questions, as always, we welcome feedback, we welcome input. It's medredefined.gima.com or you could hit us up on Twitter, Instagram, TikTok, LinkedIn, really, where everywhere, right, Josh? Yeah. Sounds good. We are everywhere. All right, man. Time to get some water in the tap water. That's right. Thank you so much for tuning into another episode of Medicine Redefined. Now, if you know somebody who has been talking about alkaline water and alkaline diets and hopping onto the trend, be sure to send them this episode. It only takes a second. And as always, everything in this podcast is for educational purposes. Only it does not constitute the presence of medicine, and we are not providing medical advice. No physician, patient, relationship is formed. Anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific, health-related issues. And if there are any topics, and I mean any topics that you want an ultimation eye to discuss on our future progress note episodes, please be sure to reach out to us. Have an awesome week.