Acid-Base Balance in Healthy Adults: Beneficial Effects of Bicarbonate and Sodium-Rich Mineral Water in a Randomized Controlled Trial: The BicarboWater Study

Background. Noncommunicable diseases (NCDs) are a global health challenge. The complex etiology of NCDs involves genetic, environmental, and lifestyle factors, including dietary habits. Chronic latent metabolic acidosis has been associated with an increased risk of NCDs. Alkalizing diets and mineral water consumption have shown promise in improving acid-base balance and potentially impacting NCDs. Methods. In this randomized controlled intervention study, the effect of drinking 1,500-2,000 mL of mineral water daily on acid-base balance was evaluated. Ninety-four healthy participants were divided into two groups: one consumed mineral water with a high bicarbonate and sodium content (HBS, n = 49) and the other consumed mineral water with a low bicarbonate and sodium content (LBS, n = 45). Changes in venous blood gas and urinary acid-base parameters were measured over a short-term (3 days) and long-term (28 days) intervention period. Potential renal acid load (PRAL) and nutrient intake were calculated at baseline and after 28 days. Results. HBS water consumption led to increased urinary pH (24-hour urine and spontaneous urine, both p < 0.001) and bicarbonate levels (p < 0.001), accompanied by reduced titratable acids (p < 0.001) and ammonium (p < 0.001), resulting in a lower renal net acid excretion (p < 0.001). These changes occurred in the short term and persisted until the end of the study. LBS consumption showed no significant effects on urinary pH but led to a slight decrease in bicarbonate (p < 0.001) and NH4 (+) (p < 0.001), resulting in a slight decrease in NAE (p=0.011). Blood gas changes were modest in both groups. Mineral water consumption in the HBS group altered dietary intake of sodium and chloride, contributing to changes in PRAL values.Conclusion. The study demonstrates that the consumption of mineral water high in bicarbonate and sodium (1,500 mL-2,000 mL/day) can positively influence urinary acid-base parameters and reduce NAE, suggesting potential benefits in maintaining acid-base balance without adverse effects on human health. These findings highlight the importance of mineral water composition in acid-base regulation. This trial is registered with DRKS00025341.