Hydrogen-Rich (H+) Water Helps Athletes Perform, Improves Our Health & Prolongs Our Lives, Really? - True or False

Is H+ rich water more effective than other 'snake oil versions' of water?

Recently, Raymond asked on the SuppVersity Facebook page whether I could "please do something on the subject of hydrogen supplementation via water or gas" - and that's what I plan to do today.

As Raymond rightly points out, the use of H+ water "seems to be a big deal in longevity circles, and perhaps it holds promise for 'our crowd' as well". The obvious question is: rightly so? Or, more specifically, is there credible evidence that H+ water has ergogenic and health-promoting effects in gymrats, athletes, and Mr. & Mrs. Average Joe.

If you want to make your water "ergogenic", use it to boil a fresh coffee ;-)

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Unfortunately, the best evidence in favor or H+ therapy comes from rodents, where hydrogen gas of less than 4 % was given by inhalation. If we follow Ichihara, et al. and summarize the results of pertinent studies, we would find a broad range of pathologies that includes 31 disease categories and 166 disease models, including human diseases, as well as treatment-associated pathologies with a predominance of oxidative stress-mediated diseases and inflammatory diseases.

Table 1: Overview of Clinical trials published as of June 2015 (from Ichihara, et al. 2015).

So, yes there's evidence that H+ treatments (specifically in gaseous form) can have health benefits - at least in common models of human disease. Evidence that guzzling expensive H+ water will have immediate or chronic performance enhancing effects are yet as scarce as RCTs that would confirm the practical relevance of the results of in vitro and animal studies in healthy or sick human beings.
In humans and with respect to the significantly more popular consumption of H+ water, however, we have almost only pilot studies like the one by Aoki et al. (2012):

• Anti-fatigue effects in soccer players (Aoki, et al. 2012) --  In the study from the University of Tsukuba, each of the 10 soccer players who participated in the study was examined twice in a crossover double-blind manner; they were given either HW or placebo water (PW) for one-week intervals. Subjects were requested to use a cycle ergometer at a 75 % maximal oxygen uptake (VO2) for 30 min, followed by measurement of peak torque and muscle activity throughout 100 repetitions of maximal isokinetic knee extension. Oxidative stress markers and creatine kinase in the peripheral blood were sequentially measured.
  

  

  Figure 1: Unimpressive - Sequential changes of blood lactate levels during exercise. Blood lactate levels in the athletes given PW significantly increased immediately after exercise compared to the levels at pre-exercise (*p < 0.05 vs. time 0. #p < 0.05 vs HW, N = 10 | Aoki. 2012).

  An analysis of the data shows that the oral intake of HW prevented an elevation of blood lactate during heavy exercise. That alone is not enough to impress anyone, but since HW also ameliorated the early peak torque decline during maximal isokinetic knee extension. On the other hand, significant changes in blood oxidative injury markers, such as d-ROMs and BAP, or creatine kinase after exercise were not observed.

Even though the lactate reduction is not half as relevant as the "lactate hypothesis of fatigue" would suggest (Taylor. 2016), it is still interesting to see that H+ has opposite effects to bicarbonate, which has been shown to allow for significant increases in lactate production by buffering the conversion of this alternative brain and muscle fuel to performance impairing lactic acid.

Don't confuse H+ water with deep sea water (DSW): If you want to learn more about the latter, I suggest you read the most recent review from Malaysia (Nani, et al. 2016) | download for free

Whether that's also why H+ has been found to inhibit the growth of colon cancer cells in vitro and if the results of Runtuwene, et al. have any real-world relevance, requires further research.

Figure 2: Schematic summary of molecular mechanisms of hydrogen (Ichihara. 2015).

Potential physiological mechanisms that could explain the anti-cancer effect, as they are illustrated graphically in Figure 2 from Ichihara, et al. (2015), have been identified years ago. The "master regulator(s) that drive these modifications, however, remain to be elucidated and are currently being extensively investigated" (Ichihara. 2015), and as of now, it has not been identified.

Don't waste your money on oxygen-enriched (O-) water either! In the conclusion to his paper in the British Journal of Medicine a researcher from the Duke University rightly points out "oxygenated water fails both quantitative analysis and practical physiological tests of exercise performance and recovery". That's also because "[o]nly miniscule quantities of O2 can be dissolved in drinking water compared with that required for exercise, and significant intestinal absorption of O2 is unsubstantiated." In the absence of counter-evidence it is thus only logical for him to conclude that "[e]rgogenic claims for oxygenated water therefore cannot be taken seriously" (Piantadosi. 2006).

And yet, in view of the fact that a reduction in oxidative stress and inflammation appears to be an essential downstream effect of the effects of H+ on one or several unknown "master regulators", it can hardly surprise us that there are studies to suggest...

• 

  Figure 3: Plasma glucose and insulin concentrations in response to a 75-g OGTT before (○) and after (●) consumption of hydrogen-rich pure water for 8 weeks in 6 patients with IGT (Kajiyama. 2008).

  improvements in glucose management in type II diabetics (Kajiyama. 2008); the test water of which the subjects consumed 900ml/day for 8 weeks was produced by dissolving hydrogen gas directly into the pure water, yielding hydrogen-rich pure water with the following physical properties: pH 6.7 ± 0.1, low electric conductivity (0.9 ± 0.2 μS/cm), high dissolved hydrogen (1.2 ± 0.1 mg/L), low dissolved oxygen (0.8 ± 0.2 mg/L), and an extremely negative redox potential (−600 ± 20 mV)
• increased antioxidant defenses & improved lipids in subjects with metabolic syndrome (Nakao. 2012; Song. 2013); 1.5–2 L/day and 0.8-1 L/day administered for 8 weeks and 10 weeks in Nakao et al. and Song et al., respectively 
• improved oxidative status and quality of life in patients treated with radiotherapy for liver tumors (Kang. 2011); in the study hydrogen-rich water was produced by placing a metallic magnesium stick into drinking water (final hydrogen concentration; 0.55~0.65 mM)

Whether and to which extent this is related to or corollary with the increase in pH Ostojic and Stojanovic (2014) observed in exercised subjects in response to 14 days on 2l of hydrogen-rich water per day. In said study, the subjects', "52 presumably healthy physically active male volunteers" (Ostojic. 2014),

"[...i]ntake of HRW significantly increased fasting arterial blood pH by 0.04 (95% confidence interval; 0.01 - 0.08; p < 0.001), and postexercise pH by 0.07 (95% confidence interval; 0.01 - 0.10; p = 0.03) after 14 days of intervention. [In addition, f]asting bicarbonates were significantly higher in the HRW trial after the administration regimen as compared with the preadministration (30.5 ± 1.9 mEq/L vs. 28.3 ± 2.3 mEq/L; p < 0.0001)" (Ostojic. 2014).

If that was the mechanism, though, you'd yet be better off with bicarbonate supplementation which will lead to much more significant improvements in pre- and post-exercise pH. And as if the lack of an understanding of the mechanism was not yet enough, the fact that many have been conducted in thoroughbred horses is likewise not exactly adding to the persuasiveness of the few studies that focus on the purported ergogenic effects of H+ (Tsubone. 2013).

As scarce as the evidence of health benefits (Ohta. 2014) of H+ may be, it is much more convincing than the quasi-non-existent evidence for relevant ergogenic effects. 

So what? The evidence for health benefits of H+ water consumption or H+ inhalation, as scarce as it may be, is, almost extensive compared to the number of studies that investigated the often-advertised performance enhancing effects of H+ water - performance enhancing effect of which the only reliable human RCT shows that they are at best statistically, but hardly practically relevant.

Based on the currently available evidence, H+ water consumption / H+ gas inhalation can thus hardly be recommended  as an ergogenic practice in gymrats and/or pro-athletes | Comment on Facebook!

References:

• Aoki, Kosuke, et al. "Pilot study: Effects of drinking hydrogen-rich water on muscle fatigue caused by acute exercise in elite athletes." Medical gas research 2.1 (2012): 1.
• Ichihara, Masatoshi, et al. "Beneficial biological effects and the underlying mechanisms of molecular hydrogen-comprehensive review of 321 original articles." Medical gas research 5.1 (2015): 1.
• Kajiyama, Sizuo, et al. "Supplementation of hydrogen-rich water improves lipid and glucose metabolism in patients with type 2 diabetes or impaired glucose tolerance." Nutrition Research 28.3 (2008): 137-143.
• Kang, Ki-Mun, et al. "Effects of drinking hydrogen-rich water on the quality of life of patients treated with radiotherapy for liver tumors." Medical gas research 1.1 (2011): 1.
• Nani, Samihah Zura Mohd, et al. "Deep Sea Water: Beneficial Resource for Health." Evidence-Based Complementary and Alternative Medicine (2016).
• Ohta, Shigeo. "Molecular hydrogen as a preventive and therapeutic medical gas: initiation, development and potential of hydrogen medicine." Pharmacology & therapeutics 144.1 (2014): 1-11.
• Ostojic, Sergej M., and Marko D. Stojanovic. "Hydrogen-rich water affected blood alkalinity in physically active men." Research in Sports Medicine 22.1 (2014): 49-60.
• Nakao, Atsunori, et al. "Effectiveness of hydrogen rich water on antioxidant status of subjects with potential metabolic syndrome-an open label pilot study." Journal of clinical biochemistry and nutrition 46.2 (2010): 140-149.
• Piantadosi, Claude A. "“Oxygenated” water and athletic performance." British journal of sports medicine 40.9 (2006): 740-741.
• Runtuwene, Joshua, et al. "Hydrogen–water enhances 5-fluorouracil-induced inhibition of colon cancer." PeerJ 3 (2015): e859.
• Song, Guohua, et al. "Hydrogen-rich water decreases serum LDL-cholesterol levels and improves HDL function in patients with potential metabolic syndrome." Journal of lipid research 54.7 (2013): 1884-1893.
• Taylor, Janet L., et al. "Neural Contributions to Muscle Fatigue: From the Brain to the Muscle and Back Again." Medicine and science in sports and exercise (2016).
• Tsubone, Hirokazu, et al. "Effect of treadmill exercise and hydrogen-rich water intake on serum oxidative and anti-oxidative metabolites in serum of thoroughbred horses." Journal of equine science 24.1 (2013): 1.

Supercharging Creatine With Baking Soda: Study Shows Increased Peak Power and Endurance - Plus: How Bicarbonate Could Help You Lose Fat & Build Muscle

The pH of your urine is not a reliable measure of your bodies acid base-status

I have written about the "love affair" of creatine and baking soda before. Once, in the "The Pharmacokinetics of Creatine" series (Part I, Part II), where I outlined how you can "brew" your own KreAlkalyn replacement using creatine and NaHCO3, and another time back in 2010, when I discussed the data from a dissertation by James J Barber, who had conducted a preliminary investigation into the joint ergogenic effects of N-Amidinosarkosin (creatine) and NaHCO3 (baking soda) on the repeated sprint performance of recreational athletes.

You can learn more about beta alanine & bicarbonate at the SuppVersity

The Hazards of Acidosis

Build Bigger Legs W/ Bicarbonate

HIIT it Hard W/ NaCHO3

BA + Bicarb are Synergists

Bicarb Buffers Creatine

Beta Alanine Fails to HIIT Back

The complete results of a follow up investigation by Barber, who now works at the Human Performance Laboratory at the California Polytech State University, are going to be published in the next issue of the Journal of Strength and Conditioning Research (Barber. 2012); and they underline what you, as a diligent student of the SuppVersity, knew all along: Baking soda is not only cheaper than 99% of the commercially available supplements, it is also more ergogenic than the average junk the guy at GNC is trying to sell to you.

Soda? But that must be bad for you?! False!

For their study, the researchers recruited a group of 13 healthy previously trained (>5h of aerobic and >2h of HIT per week) young men (age 21.1 ± 0.6 yrs, BMI 23.5 ± 0.5 kg/m²; VO2Max 66.7 ± 5.7 ml/kg-min). In a double-blinded crossover fashion (meaning that each participant had to complete every condition, i.e. "crossover", and neither he, nor the researchers knew whether he had been given the active or the placebo treatment, i.e. "double-blinded"), the men had to consume a supplement containing either

• placebo: 20g maltodextrin + 0.5g/kg maltodextrin,
   
• creatine (only): 20g creatine + 0.5g/kg maltodextrin, or
   
• creatine + NaHCO3: 20g creatine + 0.5g/kg baking soda*
  
  * for all supplement the total dosage was divided into four smaller doses, which were to be taken at 9:00 a.m., 12:00 p.m., 6:00 p.m., and 10:00 p.m.; the subjects also completed a 48h dietary recall and were asked to consume identical foods during each condition

before their peak power, mean power, relative peak power, and bicarbonate concentrations were assessed during six subsequent 10-second repeated Wingate sprint tests on a cycle ergometer with 60s rest periods between each sprint. To preclude any carry-over effects from previous tests, or rather supplementation, each experiment was followed by a three-week washout period.

Figure 1: Total and relative peak power output (left) and relative peak power output in the individual trials (right; data adapted from Barber. 2012)

As you can see in figure 1, Barber et al. were able to confirm his initial results. Interestingly, only the creatine + NaHCO3, yet not the creatine only regimen elicited statistically significant increases in both the relative power output (in W/kg; p < 0.05 for both) and the total power output (p < 0.05 only in the creatine + NaHCO3 trial; cf. figure 1, left). Moreover, the creatine + NaHCO3 supplementation lead to "the greatest attenuation of decline in relative peak power over the 6 repeated sprints." (cf. figure 1, right).

Creatine + baking soda: Additive or synergistic effects

An interesting question the scientists probably ignored, because their GNC guy did not yet tell them about the "extraordinary superiority of buffered creatine", is whether the ~37g of sodium bicarbonate the subjects ingested simply added to the beneficial effects the 20g of creatine had on the repeated sprint performance of the athletes, or whether the baking soda also decreased the breakdown and facilitated the uptake of creatine (cf. figure 2)

Figure 2: Relative increase in creatine in dry muscle mass of horses, after supplementation with creatine monohydrate, Kre-Alkalyn or Gastner's patented creatine + sodium carbonate +sodium hydrogen carbonate formula (posted first in "The Pharmacokinetics of Creatine: Part 1/2" based on Gastner. 2010)

And while it may not be important for your HIIT sessions, whether the mechanism behind the performance increase is additive of synergistic, it could well make the one-rep difference on a deadlift or bench press competition, in the course of which each additional phosphocreatine molecule counts.

"Cholesterol is the devil and sodium is his little brother!" Everyone who still believes everything the medical orthodoxy says, please raise your hands!

A note on the dangers of "salt": Firstly, baking soda is "only" ~28% sodium, which means that for every 4 grams you ingest you get roughly 1 g of sodium. Secondly, it is arguable how much of the sodium is effectively taken up and will be floating around in your blood. As T. Lakhanisky points out in his dossier for the Belgian government: "The uptake of sodium, via exposure to sodium carbonate, is much less than the uptake of sodium via food. Therefore, sodium carbonate is not expected to be systemically available in the body." (Lakhanisky. 2002) And thirdly, there is more and more evidence that suggests that the chloride rather than the sodium content of common table salt (NaCl = NatriumChloride) is the root cause of "sodium induced hypertension" in "sodium sensitive" individuals / animal models. Only recently, a study by Schmidlin et al. showed that chloride loading induced hypertension in the stroke-prone spontaneously hypertensive rat despite profound sodium depletion (Schmidlin. 2010). So, if you asked me, rather than pointing at salt as the #2 on the list of greatest evils (obviously cholesterol is still #1, here) the medical orthodoxy would be better advised to address the imbalances between sodium and potassium, which are so characteristic of the western diet, instead of painting yet another black and white picture where sodium is the bad guy and potassium the dangerous mineral that cannot be sold OTC in dosages >80mg.... but hey, this would be the topic for a whole new blogpost and as gross as it may sound, the chance that you get diarrhea from the baking soda is probably 1000x higher than the remote possibility of increases in blood pressure. A 1990 study by Luft et al. even found that the blood pressure of 10 mildly hypertensive and normal subjects decreased by 5mmHg after 7 days in the course of which they drank 3 liters of sodium bicarbonate containing water per day (Luft. 1990)

If you add to that all the previously reported benefits you can derive from a few tablespoons of baking soda

• +34% time to exhaustion and +91% total work during HIIT (Feb 29, 2012)
• synergistic and superior effects compared to beta alanine (Feb 20, 2012)
• protection against stress induced oxidative damage to white blood cells (Nov 28, 2011)
• increased performance in tennis players (Nov 4, 2010)

and obviously Barber's own previously reported results, you may understand why I urged our common friend Adelfo Cerame Jr to supplement with bicarbonate throughout his whole contest prep.

Latent metabolic acidosis hampers weight loss and muscle gains

Figure 3: The contribution of latent acidoses to the obesity epidemic and maybe even your inability to build muscle and/or lose weight
(based on Berkemeyer. 2009)

And even when you are not interested in your performance, a 2009 paper by Shoma Berkemeyer is by no means the only, nor the first article that linking an increased hydrogen ion concentrations (latent acidity, which can be countered by dietary bicarbonate) to weight gain and the obesity epidemic (Berkemeyer. 2009, cf. my summary in figure 3).

In view of the fact that even a latent H+ surplus could apparently compromise your efforts to lose fat and build muscle, it should be obvious that you better make sure to have enough alkalizing greens (and optional supplemental bicarbonate; not necessarily 30g, though ;-) in your diet - no matter if the whole acid/base balance issue, esp. the role of a high protein intake, is still very controversial.

More scientific evidence for the combination of bicarbonate & creatine in a more recent article | read it!

Practically speaking, what do I do? Since loading is not necessary unless you have a competition right ahead and this is the first time you take creatine you just take 3-5g of creatine monohydrate with approximately the same amount of sodium bicarbonate per day.

Larger doses of sodium bicarbonate as they would be used for acute performance enhancing effects are (almost certainly) not necessary to increase the efficacy of creatine. If you want the acute benefits, but get diarrhea from 15-20g of bicarbonate, I suggest you try to serial load.