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Water Is Water. Period.

water-glassA topic of considerable debate in recent days is alkalized water.  From a chemical point of view this raises both eyebrows and evokes a grin.  A review of the meaning of pH might help to explain the absurdity of alkaline—or acidic, for that matter—water.   You remember that pH is a measure of acidity or alkalinity of a liquid using a scale that ranges from 0 to 14, with 7 being neutral.  Anything below 7 is an acid; above 7 an alkali (base).  The fact is that pure water is pH neutral, neither an acid nor a base.  Because the pH scale has no upper or lower limit, the range may go below zero or above 14.

If an acid is dissolved in water, the pH will drop.  The opposite applies to an alkali.  A strong acid, such as hydrochloric (HCL), has a pH of 1.0 or 0.0.  Stomach acid contains HCL, and has a pH of 1.0 to 2.0, which is quite strong.  Lye—sodium hydroxide—will bring the pH of water up to 14, a very strong base.  Because pH is a logarithmic scale, a difference of one pH unit is equivalent to a tenfold change in hydrogen concentration.  A low pH indicates a high concentration of hydrogen—or, rather hydronium, the form in which hydrogen exists in solution (a combination of H+ and H2O, making it H3O).  This is what determines pH.  Pure water has a pH of 7, having an equal number of hydronium and hydroxide (OH) ions.  By itself, hydronium is quite acidic at pH -1.7  Yes, negative.

Since pure water is pH neutral, something has to be added to it to change pH.  It isn’t the water that’s acidic or alkaline.  It’s what’s IN the water that alters the pH.  All water has both H+ and OH- ions.  More hydrogens yield acidic water; more hydroxides, alkaline.   Pure water has equal numbers of each.  Add an alkaline mineral, such as calcium or magnesium, and voila, alkaline water.  Municipal water generally contains one or both of these, therefore is alkaline.

Electrolysis of water, whereby the H’s and OH’s are separated, is an inefficient process if the water is pure.  It’s s-l-o-w, too.  But all that does is to separate the H’s from the OH’s near the electrodes, allowing very small excesses of both to build up.  Any changes in pH would be barely detectable because the H’s and the OH’s would recombine in a heartbeat.  True electrolysis requires the presence of additional ions—the minerals sold to the consumer by the alkaline water machine company.  Ordinary salt makes the water more conductive.  (Pure water is a very poor conductor.)  That salt solution will liberate hydrogen gas at the electrode (cathode) and produce alkaline water consisting essentially of sodium hydroxide (NaOH).  At the other electrode, the anode, chloride ions become chlorine, which, if allowed to mix with the hydroxides, will make a disinfectant oxidizing agent called hypochlorous acid, HOCl.

Buying a water ionizer is a costly way to get a product you could make yourself by diluting some laundry bleach.  You could adjust the pH with lemon juice.  Bleach, by the way, has a pH of about 12.6, quite alkaline.  Lemon juice is about 2.2, almost as acidic as stomach acid.  The pH of blood runs from 7.35 to 7.45.  Change that and you will likely die.  Whatever you drink will not affect blood pH because the body knows enough to grab calcium from your bones to neutralize an acidic insult, such as would come from eating too much sugar or too much protein.

If you swallow alkaline water, it will be upset by the acid in your stomach, and the effect you anticipate will not happen.  On its way to the large intestine, the place of absorption, your originally alkaline water will meet bicarbonates made by the pancreas and shot into the beginning of the small intestine.  Now, regardless of how it went in, the water is alkaline.  So, too, is all the food you swallow.

Urinary pH depends on a variety of factors, but is useful only in light of other diagnostic values, so daily pH testing is virtually futile unless you have kidney stones or gout and need to balance pH.  If you hold your breath long enough, carbon dioxide will accumulate in the blood and turn the blood acidic.  That’s uncomfortable and will force you to breathe, which will return pH to normal.  See how the body takes care of itself?  We are fearfully and wonderfully made, for sure.  But urine is the only body fluid that can have its pH changed by food or supplements, and since it’s stored in the bladder it has no effect on the pH of the rest of the body.  It’s true that excess protein, which cannot be stored, breaks down into amino acids that have the capacity to acidify the blood, but the body mobilizes calcium from bone to neutralize it immediately.  Lots of clinicians feel that too much protein may cause osteoporosis.  Calcium, magnesium, and alkaline water will not change the pH of your blood.

On the other side of this coin is acidic water…for people who don’t want to alkalize.  It’s awfully hard to keep some people happy.   This contraption is supposed to keep H3O+ in solution.  That can’t be done because it needs OH- to remain stable.  Want acid water?  Try lemon juice.  Want alkaline water?  Use baking soda, which will give you a pH of 8.3 and taste lousy.  Alka-seltzer would work, too.

No placebo-controlled, double-blinded, randomized studies have been found in the scientific literature to support the alkaline water sales pitch.  No credible evidence has been found to ascertain the benefits of alkaline water.  To be alkaline, water must contain metallic ions of some kind—sodium, calcium, or magnesium is most common.

References

University of Illinois, Dept. of Chemistry (2011-10-28).
Electrolysis of water using an electrical current.
http://www.chem.uiuc.edu/clcwebsite/elec.html.

Lower, S.
“Ionized” and alkaline water: Snake oil on tap.
http://www.chem1.com/CQ/ionbunk.html. Retrieved 2011-10-30.

Hricova D, Stephan R, Zweifel C.
Electrolyzed water and its application in the food industry.
J Food Prot. 2008 Sep;71(9):1934-47.

Greenwood NN and Earnshaw A (1997)
Chemistry of the Elements (2nd ed)

Oxford, England:  Butterworth-Heinemann

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Kidney Stones: The Basics

green-healthy-foodUreterolithiasis, renal calculi, nephrolithiasis and kidney stone all mean the same thing:  agony.  The nurse told us the pain is equivalent to passing a five-pound canned ham through the southern end of the digestive system, with the lid opened.  If you’ve never experienced the long road to relief, thank the Creator for being excused.

What causes kidney stones?

There is no single cause, but a combination of factors.  The wrong balance of fluids, minerals and acids can put you on your knees faster than being knighted.  If urine has more crystal-making elements than the fluid can dilute, bingo, you have the makings of a stone…or stones.  In looking for a definitive cause, science has left no stone unturned.  No pun intended.  Beneath one of those stones is fluoride, having been fingered as causative a decade ago, but only in those with symptoms of skeletal fluorosis and the propensity to form stones in the first place (Singh, 2001).  That rules lots of us out.  Whether or not high doses of vitamin C are implicated in the formation of stones is debatable and based on the status of other nutrients.  By itself, vitamin C, chemically known as ascorbic acid, is able to be converted by the body into oxalates, which increases the likelihood of making oxalate stones among stone formers who take more than the recommended upper limit of 2000 mg of vitamin C a day (Massey, 2005). But you gotta be a stone former.  Is that like a mason?   Earlier research found that high intake of vitamin B6, pyridoxine, reduces the risk of stone formation from unrestricted doses of ascorbic acid (Curhan, 1999).   Up to 500 mg of pyridoxine a day was found to be useful in the control of elevated urinary oxalates (Mitwali, 1988).  In a study reported in the New England Journal of Medicine in the dark ages of the last century, the degree of oxaluria dictates the dosage of vitamin B6.  But the degree of supplementation depends on how much B6 comes from food (Yendt, 1985).

What are they made from?

Most stones (~80%) are calcium oxalate calculi, which crystallizes in a hurry.  It’s the stuff that forms a needle-like crust on the inside of a brewery container.  If you swallowed this material, you’d get really sick, and maybe die.  Calcium oxalate crystal formation is one of the effects of ingesting antifreeze.  A small dose of calcium oxalate will make your tongue burn and swell your throat shut.  This is what happens when the cat chews on a Dieffenbachia leaf in the living room window, and then requires a trip to the vet.

Some plants, including spinach, contain calcium oxalate in their leaves. If you’re a stone former, you might choose to avoid, or at least limit, raw spinach salads, although some researchers say it doesn’t matter, as long as you’re amply hydrated and your diet is sufficiently balanced to provide calcium and vitamin B6, both of which are found in spinach (Curhan, 1999).  A little baffling, huh?  After a stone passes through the urine and gets collected in that little strainer that painters use to get the globs out of a gallon of linen white, you’ll be asked to take that stone to the doctor so he can determine its makeup.  Then he’ll know what course of action to give you.

How do I prevent kidney stones?

If ever the proverbial ounce of prevention is worth a lot, this is the place.  Most experts agree that drinking fluids is the key.  Believe us when we say that a stone former is more than willing to increase his water intake, despite its lack of flavor.  If you need flavor, try lemon juice.  Counseling in this area is simple:  if you don’t drink enough water, you’ll experience this again.  That means you have to drink even when you’re not thirsty (McCauley, 2012).  Swapping soft drinks for water is prudent (Fink, 2009).

Increasing dietary calcium intake is inversely related to stone formation.  Supplemental calcium, on the other hand, may increase risk.  Dietary calcium blocks the amount of oxalates absorbed by the body, while supplements, especially if taken between meals, spill too much of the mineral into the urine.  If calcium supplementation is needed, take it with a meal to improve absorption.  We’re cautioned not to take more than 500 mg at a time, anyway.  It’s all about the timing (Curhan, 1997).

It’s believed that most stones form in the summer, when people are more likely to get dehydrated, so we’re admonished to drink ten to twelve glasses of water a day.  Other beverages, though, fare well in the prevention category.  Caffeinated and decaffeinated coffee, tea, and wine accounted for a decreased risk of stone formation, according to the Brigham and Women’s Hospital study of the 1990’s (Curhan, 1998).

Obesity increases the risk of kidney stones, but drastic weight loss measures that rely on high protein intake can stymie the good intentions.  So, too, can laxative abuse, rapid loss of lean tissue and, naturally, poor hydration.  A diet high in fruits and vegetables can alkalize urine enough to offset oxalate and uric acid stone formation ( Frassetto, 2011).  Produce is known for its magnesium content.  Intake of magnesium is related to reduced stone manufacture, and has been a recommendation since the 17th century.  Even without overt deficiency, magnesium intake, at 500 mg a day in the form of magnesium hydroxide, was shown to decrease stone formation, and it has no adverse side effects as long as it’s not overzealously done (Johansson, 1980 and 1982).  Too much magnesium may induce laxation.  That’s an individual response.   Later study learned that magnesium combined with vitamin B6 offered a substantial decline in the risk for oxalate stones (Rattan, 1994)

Kale, turnip greens, radishes, chard and other leafy greens, broccoli, Brussels sprouts, and cabbage are good sources of dietary calcium.  Almonds and cashews, pumpkin seeds, barley, quinoa, leafy greens, white and black beans are a few good sources of magnesium.  Since calcium and magnesium compete for occupancy in the body, with calcium the winner, magnesium supplementation is a good idea.  An Epsom salts bath allows magnesium levels to increase transdermally…and it’ll help you fall asleep.  Drink water.  Prevent stones.

References

Conte A, Pizá P, García-Raja A.
Urinary lithogen risk test: usefulness in the evaluation of renal lithiasis treatment using crystallization inhibitors (citrate and phytate).
Arch Esp Urol. 1999 Jan-Feb;52(1):94-9.

Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ.
Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women.
Ann Intern Med. 1997 Apr 1;126(7):497-504.

Curhan GC, Willett WC, Speizer FE, Stampfer MJ.
Beverage use and risk for kidney stones in women.
Ann Intern Med. 1998 Apr 1;128(7):534-40

Curhan GC, Willett WC, Speizer FE, Stampfer MJ.
Intake of vitamins B6 and C and the risk of kidney stones in women.
J Am Soc Nephrol. 1999 Apr;10(4):840-5.

Curhan GC.
Epidemiologic evidence for the role of oxalate in idiopathic nephrolithiasis.
J Endourol. 1999 Nov;13(9):629-31.

Fink HA, Akornor JW, Garimella PS, MacDonald R, Cutting A, Rutks IR, Monga M, Wilt TJ.
Diet, fluid, or supplements for secondary prevention of nephrolithiasis: a systematic review and meta-analysis of randomized trials.
Eur Urol. 2009 Jul;56(1):72-80. Epub 2009 Mar 13.

Frassetto L, Kohlstadt I.
Treatment and prevention of kidney stones: an update.
Am Fam Physician. 2011 Dec 1;84(11):1234-42.

Gill HS, Rose GA.
Mild metabolic hyperoxaluria and its response to pyridoxine.
Urol Int. 1986;41(5):393-6.

Grases F, Costa-Bauzá A.
Phytate (IP6) is a powerful agent for preventing calcifications in biological fluids: usefulness in renal lithiasis treatment.
Anticancer Res. 1999 Sep-Oct;19(5A):3717-22.

Habbig S, Beck BB, Hoppe B.
Nephrocalcinosis and urolithiasis in children.
Kidney Int. 2011 Dec;80(12):1278-91. doi: 10.1038/ki.2011.336. Epub 2011 Sep 28.

Johansson G, Backman U, Danielson BG, Fellström B, Ljunghall S, Wikström B.
Biochemical and clinical effects of the prophylactic treatment of renal calcium stones with magnesium hydroxide.
J Urol. 1980 Dec;124(6):770-4.

Johansson G, Backman U, Danielson BG, Fellström B, Ljunghall S, Wikström B.
Effects of magnesium hydroxide in renal stone disease.
J Am Coll Nutr. 1982;1(2):179-85.

Massey LK, Liebman M, Kynast-Gales SA.
Ascorbate increases human oxaluria and kidney stone risk.
J Nutr. 2005 Jul;135(7):1673-7.

McCauley LR, Dyer AJ, Stern K, Hicks T, Nguyen MM.
Factors influencing fluid intake behavior among kidney stone formers.
J Urol. 2012 Apr;187(4):1282-6. Epub 2012 Feb 15.

Miggiano GA, Migneco MG.
[Diet and nutrition in nephrolitiasis].   [Article in Italian]
Clin Ter. 2007 Jan-Feb;158(1):49-54.

Mitwalli A, Ayiomamitis A, Grass L, Oreopoulos DG.
Control of hyperoxaluria with large doses of pyridoxine in patients with kidney stones.
Int Urol Nephrol. 1988;20(4):353-9.

Moyad MA.
Calcium oxalate kidney stones: another reason to encourage moderate calcium intakes and other dietary changes.
Urol Nurs. 2003 Aug;23(4):310-3.

Rattan V, Sidhu H, Vaidyanathan S, Thind SK, Nath R.
Effect of combined supplementation of magnesium oxide and pyridoxine in calcium-oxalate stone formers.
Urol Res. 1994;22(3):161-5.

Saxena A, Sharma RK.
Nutritional aspect of nephrolithiasis.
Indian J Urol. 2010 Oct;26(4):523-30.

Singh PP, Barjatiya MK, Dhing S, Bhatnagar R, Kothari S, Dhar V.
Evidence suggesting that high intake of fluoride provokes nephrolithiasis in tribal populations.
Urol Res. 2001 Aug;29(4):238-44.

Yendt ER, Cohanim M.
Response to a physiologic dose of pyridoxine in type I primary hyperoxaluria.
N Engl J Med. 1985 Apr 11;312(15):953-7.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

The Importance of Healthy Kidneys

kidney-modelBert Lance, who worked for Jimmy Carter in the Budget office, is credited with saying, “If it ain’t broke, don’t fix it,” as cited in the May 1977 issue of the magazine Nation’s Business. Sometimes we carry this admonition too far, as when we ignore body parts that don’t hurt. Not everything that’s out of order lets us know right away. It’s a lot easier to prevent damage than to fix it; just as changing the oil in your car prevents an exorbitant repair bill. The same applies to your body. Preventing ailments is easier and less painful than fixing them. Except for stones, the kidneys pretty much mind their own business, seldom letting us know they’re even there. A little maintenance goes a long way. Many people don’t even know where in the body they are or what they do.

These bean-shaped organs, about the size of a fist, are near the middle of the back, just below the ribs, one on each side of the spine. And, boy oh boy, are they sophisticated reprocessing machines. They handle nearly fifty gallons of blood a day to filter about a half gallon of waste and excess water, which you already know is stored in the bladder. The wastes come from food leftovers that float in the blood after the food’s energy supplies have been used. If these wastes weren’t removed, they’d make us sick. The actual removal of the impurities occurs in the nephrons, which are the functional units of the kidney. Each kidney has more than a million nephrons, which have tiny blood vessels that help to remove the junk, including urea, uric acid, creatinine from muscles, and excess electrolytes. Normal proteins and other materials are kept in the bloodstream to be recycled for use by the body. This includes potassium, phosphorus and sodium, among others. The kidneys also release three vital hormones—erythropoietin to stimulate the marrow to make red blood cells, renin to control blood pressure, and calcitriol (the active form of vitamin D) to help maintain calcium for bones.

If kidney function were to fail by as much as thirty percent, you probably wouldn’t even know it. That’s one of the reasons why it’s measured on blood tests, looking at creatinine, glomerular filtration rate (GFR) and blood urea nitrogen (BUN). The first of these comes from normal wear and tear on muscles; the second is an age-variable measure of how well the kidneys filter the wastes; and the third is a product of protein breakdown from the foods you eat. Proteins can also be monitored via urine. It is possible to survive with only one kidney, but living with two is nicer. If function drops to fifteen percent, either dialysis or a transplant may be necessary to sustain life.

There are things we can do to prevent kidney disorders. If there is a family history of diabetes or high blood pressure, tend to those right away. Glucose that stays in the blood instead of getting used for fuel can damage the nephrons. High BP distresses the tiny blood vessels of the nephrons, interfering with their function. Yes, there are medications to address these problems, but there also are a few dietary interventions that can keep the kidneys healthy.

Keeping sodium under control is necessary, especially as we age. Processed meals and meats contain large amounts of sodium, but so do restaurant foods, fast foods, soups and snacks. In some who are susceptible, sodium may spike BP.

The same oxygen that gives us life takes away molecular stability in the form of free radicals, which take turns stealing electrons from each other in a continuous cycle. Some come from the environment as pollution, and some from inside the body from burning food for energy. Supplying both the fat-soluble and water-soluble anti-oxidants from supplements is a good start, but that does not rule out the importance of the right diet, from which you can make the master anti-oxidant, glutathione.

Too much protein can tax the kidneys, particularly animal proteins. Mixing plant and animal sources is a safe bet. Whole grains and legumes can help. Depending on the condition of the body, however, protein intake in excess of protein need may or may not adversely affect the kidneys (Martin, 2005) (Knight, 2003). In the presence of a jeopardized kidney, elevated phosphorus levels can do harm. Meats and dairy are main sources, but food additives also contribute to the load. Phosphorus is an essential element in the diet, and in the form of phosphates is a major component of bone. It’s necessary for the manufacture of adenosine triphosphate to be burned for energy. Without it, metabolism of calcium, protein and glucose is upset. But an excess burdens the filtration load of the nephrons, and phosphate retention is linked to parathyroid malfunction.

Now, what do we eat?  Reducing sodium intake is simple. Just do it. More than 500 mg at a meal is pushing it, so you have to read labels. Canned soups can give you half a day’s worth in a single serving. You can swallow anti-oxidants from a bottle, but it’s helpful to get some from food. Berries are an excellent source, as are peppers, squashes and tomatoes. Cruciferous vegetables supply vitamin C, while onions offer quercetin, an anti-oxidant bioflavonoid that is also cardio-protective. Apples, with skins, are anti-inflammatory. Egg whites are a source of complete protein, having all the essential amino acids and less than a dozen milligrams of phosphorus. The omega-3 fats from cold-water fish—and from fish oil—can’t be beat for anti-inflammatory work (see http://oilofpisces.com/kidneydisorders.html) and olive oil is rich in polyphenols that inhibit inflammation and oxidation. A reliable research link for the study of kidney health is DaVita Clinical Research, http://www.davitaclinicalresearch.com/overview-mission.asp.

Water is an essential nutrient. Though we think that more is better, the truth is that more can be toxic. Drink too much and the kidneys can’t keep up. The cells get swollen beyond their capacity, sodium levels drop precipitously, and the firing of neurotransmitters short circuits, leading to headaches, fatigue, disorientation and even death. Thinking water will reduce protein blood test values, some people will overdo water intake and find that all they have done is dilute the protein. Even endurance athletes need to balance water intake with water loss.

A little prevention costs less than a plumber.

References

Berner YN, Shike M.
Consequences of phosphate imbalance.
Annu Rev Nutr. 1988;8:121-48.

Birn H.
The kidney in vitamin B12 and folate homeostasis: characterization of receptors for tubular uptake of vitamins and carrier proteins.
Am J Physiol Renal Physiol. 2006 Jul;291(1):F22-36.

Jane Chiu, M.Sc., Zia A. Khan, Ph.D., Hana Farhangkhoee, M.Sc., Subrata Chakrabarti, M.D., Ph.D
Curcumin prevents diabetes-associated abnormalities in the kidneys by inhibiting p300 and nuclear factor-κB
Nutrition. Volume 25, Issue 9 , Pages 964-972, September 2009

D’Amico G, Gentile MG.
Effect of dietary manipulation on the lipid abnormalities and urinary protein loss in nephrotic patients.
Miner Electrolyte Metab. 1992;18(2-5):203-6.

Duffield JS, Hong S, Vaidya VS, Lu Y, Fredman G, Serhan CN, Bonventre JV.
Resolvin D series and protectin D1 mitigate acute kidney injury.
J Immunol. 2006 Nov 1;177(9):5902-11.

Gentile MG, Fellin G, Cofano F, Delle Fave A, Manna G, Ciceri R, Petrini C, Lavarda F, Pozzi F, D’Amico G.
Treatment of proteinuric patients with a vegetarian soy diet and fish oil.
Clin Nephrol. 1993 Dec;40(6):315-20.

Kalista-Richards M.
The kidney: medical nutrition therapy–yesterday and today.
Nutr Clin Pract. 2011 Apr;26(2):143-50. doi: 10.1177/0884533611399923.

Knight EL, Stampfer MJ, Hankinson SE, Spiegelman D, Curhan GC.
The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency.
Ann Intern Med. 2003 Mar 18;138(6):460-7.

Martin WF, Armstrong LE, Rodriguez NR.
Dietary protein intake and renal function.
Nutr Metab (Lond). 2005 Sep 20;2:25.

Ogborn MR, Nitschmann E, Bankovic-Calic N, Weiler HA, Aukema HM.
Dietary soy protein benefit in experimental kidney disease is preserved after isoflavone depletion of diet.
Exp Biol Med (Maywood). 2010 Nov;235(11):1315-20. doi: 10.1258/ebm.2010.010059. Epub 2010 Oct 4.

Rayner TE, Howe PR.
Purified omega-3 fatty acids retard the development of proteinuria in salt-loaded hypertensive rats.
J Hypertens. 1995 Jul;13(7):771-80.

Soroka N, Silverberg DS, Greemland M, Birk Y, Blum M, Peer G, Iaina A.
Comparison of a vegetable-based (soya) and an animal-based low-protein diet in predialysis chronic renal failure patients.
Nephron. 1998;79(2):173-80.

National Kidney Disease Education Program
http://nkdep.nih.gov/learn/keep-kidneys-healthy.shtml

Tack, Ivan MD, PhD
Effects of Water Consumption on Kidney Function and Excretion
Nutrition Today: November/December 2010 – Volume 45 – Issue 6 – pp S37-S40

Zararsiz I, Sonmez MF, Yilmaz HR, Tas U, Kus I, Kavakli A, Sarsilmaz M.
Effects of omega-3 essential fatty acids against formaldehyde-induced nephropathy in rats.
Toxicol Ind Health. 2006 Jun;22(5):223-9.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.