Of all the things consumers buy that might kill them, bottled water seems an unlikely suspect. And yet, Nevada-based Real Water was shut down by regulators last week, and all of its products recalled, after its water was linked to multiple cases of liver disease, including one death.

Real Water sold alkaline water, a type of drinking water with a relatively high pH level that has soared in popularity in recent years. Proponents of the trend include Tom Brady and Gwyneth Paltrow, who has a promotion deal with alkaline water brand Flow. Critics include many health and nutrition professionals who declare its claims of benefits are “nonsense.”

“It makes anyone with a chemistry background want to tear their hair out,” wrote Joe Schwarcz, director of the Office for Science and Society at McGill University in Montreal.

Worldwide, alkaline water raked in $883 million in revenue in 2018, and that number was projected to nearly quintuple to $4.3 billion by 2023, according to market research firm Zenith Global. Scottsdale, Arizona-based Alkaline Water Company Inc., which produces water brand Alkaline 88, has steadily increased its Facebook following. According to Thinknum data, the company’s “likes” on the social media platform shot up more than 50 percent over the past five years.

Other popular alkaline water brands include Essentia, Core Hydration, and Bai.

Most alkaline water won’t hurt you. But there was a worrisome aspect to how Real Water manufactured its product. The company added potassium hydroxide, known commonly as “lye.”

A highly corrosive substance, lye is used in drain cleaners and hair straighteners, as well in soap-making. It is a “base,” or alkali material, with a pH of about 13. You may recall from grade school science class that a pH of 7 is “neutral” on a 0-14 scale. Anything below 7 is acidic, while anything above that level is basic. Similar compounds, also normally called “lye,” include sodium hydroxide and calcium hydroxide.

In the 1999 movie “Fight Club,” when Brad Pitt sprinkles powder on Edward Norton’s hand to inflict a painful chemical burn, it’s meant to be lye. Very small amounts of lye, mixed with water, are used safely in some cooking preparations, such as in Chinese mooncakes and corn tortillas. But for the most part, you don’t want to be consuming the stuff.

How we got to a point where a health craze evolved into mixing caustic chemicals into drinking water is something of a head-scratcher — although like most pseudoscience, it probably started with good intentions.

Water from springs has long been thought to have special health properties, fueling a decades-old bottled water industry that is now worth more than $240 billion. When water actually does come from a real spring, where it flows over rocks and picks up traces of minerals, it can naturally become alkaline. Bottlers can also artificially raise pH by using an expensive electromechanical process or adding chemicals.

The notion that alkaline water is good for you rests on the fact that human blood is slightly basic, with a pH of around 7.4. Alkaline water evangelists claim that the beverage can keep the blood at an optimal pH to ward off inflammation, cancer and other diseases. While having acidic blood does cause serious health problems, there is no evidence alkaline water makes a difference.

“The pH of your stomach is so acidic that it completely obliterates anything that you've had to drink or eat,” Charles Mueller, a New York University nutrition professor, told Refinery29.

Still, Americans seem to have an endless appetite for poorly-substantiated health fads. In the 1990s, Korean American inventor and wellness guru Sang Y. Whang wrote a book about fighting the aging process through alkaline water and foods. Whang mainly promoted the use of ionizing devices to make water more basic. He also obtained a U.S. patent in 1994 for a chemical solution for manufacturing alkaline drinking water. It contained two types of lye — sodium hydroxide and potassium hydroxide.

In the early 2000s, naturopath Robert O. Young further popularized alkaline diets in books focusing on the purported benefits of regulating pH levels in the body. Young later served prison time for practicing medicine without a license, and was ordered by a court to pay $105 million to a cancer patient who followed his advice by forgoing traditional chemotherapy and trying his diet instead. 

Today, wellness crazes, including new water trends, spread even more quickly than in the past thanks to social media like Instagram. People seeking to “optimize” hydration have attributed miraculous properties to drinking untreated “raw” water (possibly dangerous), water with extra hydrogen molecules (benefits unproven), or water with lemon (refreshing, but that’s about it). And beverage companies have been quick to cash in.

Real Water produced its packaged drinking water using a concentrate made with filtered municipal tap water, potassium bicarbonate, magnesium chloride and potassium hydroxide. The company also claimed to use an ionizer to further alter the water. The product was sold in Arizona, Nevada and California as “premium” drinking water and a “healthy” alternative to tap water, according to court documents.

In March, the U.S. Food and Drug Administration was notified about five infants and children who had developed non-viral hepatitis and acute liver failure after consuming Real Water’s beverages. An investigation turned up many more complaints of nausea and vomiting related to the product. The agency found the product was adulterated and misbranded, both because of safety issues with the chemical additives and because of unsanitary manufacturing practices.

Real Water and its executives reached an agreement with the regulators, filed in Nevada federal court this month, in which they consented to recalling and destroying all of their products, and refraining from further sales until completing an extensive safety remediation plan. They also agreed to pay costs of FDA investigation and supervision at rates of as much as $122.71 per hour.

About the Data:

Thinknum tracks companies using the information they post online, jobs, social and web traffic, product sales, and app ratings, and creates data sets that measure factors like hiring, revenue, and foot traffic. Data sets may not be fully comprehensive (they only account for what is available on the web), but they can be used to gauge performance factors like staffing and sales.

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