REVIEW ARTICLE Health Efects of Alkaline Diet and Water, Reduction of Digestive-tract Bacterial Load, and Earthing Haider Abdul-Lateef Mousa, MB ChB, MSc ABSTRACT In the article, the author discusses the issue of chronic, low-grade acidosis that is thought to be brought about primarily by 2 factors: (1) advancing age, with a consequent decline in renal function; and (2) diet. An acid-forming diet can induce low-grade metabolic acidosis, which causes very small decreases in blood pH and plasma bicarbonate (HCO3-) that remain within the range considered to be normal. However, if the duration of the acidosis is prolonged or chronically present, even a low degree of acidosis can become signiicant. his article reviews supporting evidence in the literature that has shown that consumption of abundant alkaline-forming foods can result in improvement in bone mineral density (BMD) and muscle mass, protection from chronic illnesses, reduced tumor-cell invasion and metastasis, and efective excretion of toxins from the body. In addition, a large number of studies showing the beneits of alkaline-forming foods have revealed that people consuming water with a high level of total dissolved solids (TDS) (ie, with a high mineral content) have shown a lower incidence of coronary heart disease (CHD), cardiovascular disease (CVD), and Haider Abdul-Lateef Mousa, MB ChB, MSc, is a lecturer in the College of Medicine at the University of Basrah in Basrah, Iraq. Corresponding author: Haider Abdul-Lateef Mousa, MB ChB, MSc E-mail address: haideramousa@gmail.com T he human body tends to maintain a tightly controlled pH range of approximately 7.35 to 7.45 in the extracellular luid through respiratory excretion of carbon dioxide and renal excretion of a noncarbonic (ie, a nonvolatile) acid or base.1 Everyday metabolism produces acid as nonvolatile sulfate from amino-acid catabolism, nonmetabolized organic acids, and phosphoric and other acids. he kidney reabsorbs all of the iltered bicarbonate (HCO3-) and generates new HCO3- in the 24 ALTERNATIVE THERAPIES, VOL. 22 NO. S1 cancer and lower total mortality rates. Consumption of alkaline water also may prevent osteoporosis and protect pancreatic beta cells with its antioxidant efects. In addition, this article discusses the literature that shows that reducing acid production by digestive-tract bacteria can play an important role in increasing blood alkalinity toward the normal upper limit. hat change occurs through good oral hygiene, lossing of teeth, perfect chewing of food, and bowel evacuation as soon as possible. Finally, the author reviews the literature that shows that earthing (ie, the direct contact of the human body with the earth) can supply a current of plentiful electrons. Earthing has been shown to reduce acute and chronic inlammation, blood glucose in patients with diabetes, red blood cell (RBC) aggregation, and blood coagulation. It also has been shown to produce symptomatic improvement in chronic, muscle and joint pain, a reduction in overall stress levels and tensions, a boost in positive moods, an improvement in heart rate variability, and an improvement in the immune response. (Altern her Health Med. 2016;22(S1):##-##.) collecting duct. Under normal steady-state conditions, the net quantity of acid secreted and the consequent renal generation of new HCO3- equals the rate of metabolic proton generation, preserving pH balance. In metabolic acidosis, either nonvolatile acid accumulates or HCO3- is lost (eg, in diarrhea) and that result can occur even when the plasma HCO3- is within the range considered to be normal (24-28 mmol/L).2 An acid-forming diet can induce low-grade metabolic acidosis, which causes very small decreases in blood pH and plasma HCO3-, that remain within the range considered to be normal. Within that range, the system equilibrates nearer the lower end rather than the higher end of normal. However, if the duration of the acidosis is prolonged or chronically present, even a low degree of acidosis can become signiicant. A less severe but more chronic, lowgrade acidosis is thought to be brought about primarily by 2 factors: (1) advancing age, with a consequent decline in Mousa—Alkaline Diet and Water, Bacterial Load, and Earthing renal function; and (2) diet, which may promote acidosis both by its net acid load and by its sodium-chloride content. With age, the severity of diet-dependent acidosis increases independently of the diet, most likely due to a decline in the kidney’s functional capacity.3-5 Renal insuiciency contributes to metabolic acidosis by reducing conservation of HCO3 and excretion of acid. With the agricultural revolution of the last 100 centuries and, even more recently, with the industrialization of the last 2 centuries, a decrease has occurred in potassium as compared with sodium in the diet, and an increase in chloride has also resulted as compared with HCO3-. Humans today have a diet poor in magnesium and potassium as well as in iber and rich in saturated fat, simple sugars, sodium, and chloride as compared with the preagricultural period.6 he ratio of potassium (K) to sodium (Na) has reversed; K/Na previously was 10 to 1, whereas the modern diet has a ratio of 1 to 3.3 It has been documented that severe forms of metabolic acidosis in children, such as renal tubular acidosis, are associated with low levels of growth hormone, with a consequent short stature. Correction of the acidosis with HCO3- or potassium citrate3,7 has been found to raise levels of growth hormone remarkably and improve growth. he use of suicient potassium bicarbonate in the diet to neutralize the daily net acid load in postmenopausal women has been shown to produce a signiicant increase in growth hormone and, consequently, of osteocalcin.8 Improving levels of growth-hormone may improve quality of life and body composition, reduce cardiovascular risk factors, and even improve memory and cognition.9 he aim of the present article is to investigate the role of the use of an alkaline diet and alkaline water, of a reduction in acid formation by digestive-tract bacteria, and of earthing as natural means for health promotion and prevention of chronic illnesses. hose roles are selected as one topic because they are all natural and are interrelated, providing cumulative, powerful, and beneicial health efects. he author studied those efects using independent papers, and they were not investigated or reviewed together as a single interrelated subject. he implementation of those natural factors could be available to all people with a low cost. It may have signiicant interest for the whole world through a reduction of the high costs of treatment for chronic diseases. he current review was conducted according to the guidelines for Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE)10 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).11 he National Library of Medicine (PubMed) database was searched from its earliest records through June 2015, using the keywords alkaline diet, alkaline acid food, alkaline water, mineral water, drinking water, earthing, grounding, and blood pH. he type of search used was limited to English-language studies. In addition, other related references were manually searched. he articles with positive and negative outcomes were included in the review to avoid any bias in the selection. he data were obtained from epidemiological studies, clinical Mousa—Alkaline Diet and Water, Bacterial Load, and Earthing trials, case-control studies, cohort studies, experimental studies, in vitro research, animal research, systematic reviews, meta-analyses, the World Health Organization’s (WHO’s) reports, and published books. ALKALINE DIET Most food has the potential to alter the body’s pH. When digested, some foods leave acidic by-products in the body (ie, they are acid-forming foods); others leave alkaline by-products (ie, they are alkaline-forming foods). Acidforming foods include most high-protein foods, such as meat, ish, and eggs and most legumes, such as beans and peas. Sugar, alcohol, and most grains are also acid forming. Alkaline-forming foods include nearly all vegetables and fruits, many nuts and seeds, and spices and are shown in Table 1, which lists the potential renal acid loads (PRALs) of various foods.12 he term alkaline diet, also known as the alkaline ash diet, alkaline acid diet, acid ash diet, and the acid alkaline diet, describes a group of loosely related diets based on the fact that certain foods can afect the acidity of body luids, including the urine or blood and can, therefore, be used to treat or prevent diseases. Alkaline food sources or supplements are cations— sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium (Mg2+)—that decrease calciuria and exert a protective efect on bone.13,14 On the other hand, acid foods or supplemental sources are anions—phosphate (PO4–), sulfate (SO4–), chloride (Cl–), and organic acids—that cause metabolic acidemia and increase calciuria when consumed in excess, which is harmful to bone health.13,15,16 Both sodium and potassium belong to the alkaline category; however, the movement of the ratio toward a higher potassium intake can have favorable health efects. According to the acid-ash hypothesis, protein and grain foods are detrimental to bone health because of production of sulfate and phosphate,12,13 whereas fruit and vegetables are bone protective because of their potassium-organic-anion content.17 Whole grains in comparison with reined ones are rich in minerals (ie, are an alkaline source) and have vitamins that might have protective efects on bone. A recent Korean study investigated the role of consumption of whole grains, dairy products, and fruits on bone health.18 It suggested that a high intake of those products may contribute positively to the bone health of the adult population. No further studies could be found regarding the diferent efects of reined and whole grains on bone health. Additional studies to investigate such efects are suggested. Another study also concluded that excessive dietary protein from foods with a high potential renal-acid load adversely afects bone, unless bufered by the consumption of alkali-rich foods or supplements.19 In vitro studies have shown that metabolic acidosis induces a calcium elux from bone.20 In animal and human studies, an acid environment has been associated with a negative calcium balance and increased bone resorption.21,22 Further, any extracellular acidiication enhances osteoclastic activity, which raises the ALTERNATIVE THERAPIES, VOL. 22 NO. S1 25 Table 1. PRALs of Selected Foods11 Food or Food Group Dairy Parmesan cheese Processed cheese, plain Cheddar, reduced fat Hard cheese (average) Fresh cheese (quark) Cottage cheese, plain Yogurt, whole milk Ice cream Whole milk Buttermilk Eggs Eggs, yolk Eggs, white Eggs, chicken whole Meats Corned beef Luncheon meat, canned Turkey Veal Lean beef Frankfurters Sugars Sugar, white Honey Vegetables Cucumber Broccoli Tomato Eggplant Celery Spinach Fats and oils Butter Margarine Olive oil Fruits, nuts, and fruit juices Peanuts Walnuts Grape juice, unsweetened Orange juice, unsweetened Apples or apple juice, unsweetened Apricots Bananas Black currents Raisins Grains and grain products Brown rice Rolled oats Spaghetti, whole grain Spaghetti, white Cornlakes Rice, white Bread, rye lower Bread, whole wheat Legumes Lentils, green and brown Green beans Fish Trout, brown Cod illets PRAL mEq of Cl+ PO4+ SO4Na- K- Ca- Mg 34.2 28.7 26.4 19.2 11.3 8.7 1.5 0.8 0.7 0.5 23.4 1.1 8.2 13.2 10.2 9.9 9.0 7.8 6.7 -0.1 -0.3 -0.8 -1.2 -3.1 -3.4 -5.2 -14.0 0.6 -0.5 0.0 8.3 6.8 -1.0 -2.9 -2.2 -4.8 -5.5 -6.5 -21.0 12.5 10.7 7.3 6.5 6.0 4.6 4.1 1.8 3.5 -3.1 10.8 7.1 26 ALTERNATIVE THERAPIES, VOL. 22 NO. S1 Food or Food Group Beverages Beer, pale Cola Beer, drat Wine, white Cofee infusion Wine, red PRAL mEq of Cl+ PO4+ SO4Na- K- Ca- Mg 0.9 0.4 -0.2 -1.2 -1.4 -2.4 Note: A negative PRAL score indicates that the food is basic or alkaline, and a positive PRAL score indicates that the food is acidic. A score of 0 indicates that the food is neutral. Abbreviations: PRALs, potential renal acid loads; mEq, milliequivalents; Cl+, chloride; PO4+, phosphate; SO4-, sulfate; Na-, sodium; K-, potassium; Ca-, calcium; Mg, magnesium. absorption and removal of osseous tissue.23 In vitro tests of the alkaline-phosphatase activity of osteoblasts, which had peaked strongly near pH 7.4, was reduced 8-fold at pH 6.9.24 hus, in uncorrected acidosis, the deposition of alkaline mineral in bone by osteoblasts is reduced, and resorptive activity by osteoclasts is increased to maximize the availability of hydroxyl ions in solution to bufer protons.24 With a long-term, nutritional acidic load, pH is kept constant at the expense of bone, which delivers the bufering substances through bone resorption.25 Acidosis was also found to exert a powerful, reciprocal, inhibitory efect on the mineralization of bone matrix by cultured osteoblasts. hat efect was caused by increased alkaline-mineral solubility at a low pH, together with selective inhibition of alkaline phosphatase, which is required for mineralization. herefore, diets or drugs that shit the acid-base balance in the alkaline direction might provide useful treatments for bone-loss disorders.26 In a study by Krieger et al,27 metabolic acidosis, which occurs during renal failure, renal insuiciency, or renal tubular acidosis, was shown to result in a decreased systemic pH and was associated with an increase in excretion of urine calcium, which would come partly at the expense of bonemineral stores. Administration of HCO3- for 3 months showed a favorable efect on bone resorption and calcium excretion. hat inding suggests that increasing the alkali content of the diet may attenuate bone loss in healthy older adults.28 Sot-drink consumption may have adverse efects on bone mineral density (BMD). Colas contain cafeine and phosphoric acid (H3PO4) and may adversely afect bone because they are acidic beverages. It has been found that intake of cola, but not of other carbonated sot drinks, was associated with low BMD in women.29 Evidence is increasing that consumption of a Western diet is a risk factor for osteoporosis through an excess acid supply, whereas fruits and vegetables balance the excess acidity, mostly by providing potassium and HCO3--rich Mousa—Alkaline Diet and Water, Bacterial Load, and Earthing foods. Western diets consumed by adults produce approximately 50 to100 mEq acid per day; therefore, healthy adults consuming such a diet are at risk of chronic, low-grade metabolic acidosis, which worsens with age as a result of declining kidney function.30 Supporting evidence is available that alkaline-forming foods and nutrients can help in bone maintenance. A balanced diet with abundant fruits and vegetables and adequate protein has been found to be important to BMD,22 whereas among older adults, inadequate protein intake has been shown to cause a greater problem for bone health than protein excess.31 One study has revealed a small, but signiicant, positive association between a diet that is abundant in alkaline foods and muscle-mass indexes in healthy women; the result was independent of age, physical activity, and protein intake.29 hus, a higher intake of foods rich in potassium, such as fruit and vegetables, might favor the preservation of muscle mass in older men and women.32,33 Acid pH has been shown to stimulate tumor-cell invasion and metastasis in vitro and in vivo, whereas oral sodium bicarbonate (NaHCO3) has been shown to increase the pH of tumors selectively and to reduce the formation of spontaneous metastases in mouse models of metastatic breast cancer. 34 Use of NaHCO3 as a treatment regimen has been shown to increase the extracellular pH signiicantly but not the intracellular pH.34 he increasing dietary acid load in the modern diet can lead to a disruption in acid-alkaline homeostasis in various body compartments and, eventually, can result in chronic disease through repeated borrowing of the body’s alkaline reserves. Adjustment of tissue alkalinity, particularly within the kidney’s proximal tubules, can lead to a more efective excretion of toxins from the body. Metabolic detoxiication using a high-vegetable diet in conjunction with supplementation with an efective alkalizing compound, such as potassium citrate, may shit the body’s reserves to become more alkaline.35 ALKALINE (MINERAL) WATER Total dissolved solids (TDS) is the term used to describe the inorganic salts and small amounts of organic matter present in solution in water. In many developing countries with no clean water supplies, or with water that is high in salt or that has a high level of TDS, a trend has occurred for people to consume reverse osmosis (RO) water in which the TDS ranges from 80 to 110, with a pH ranging from 6.8 to 7.2. hat water is relatively deicient in essential alkaline minerals as compared with water from natural springs or rivers. Further, most people think that water that is free of the taste of salt is the best, which is incorrect. People in some countries also have a tradition of collecting rainwater into reservoirs for drinking purposes. Such water has insuicient minerals and might be acidic as a result of carbon-dioxide dissolution (ie, carbonicacid formation). On the other hand, consumption of mineral water has increased prominently in the developed world.36 Usually, the Mousa—Alkaline Diet and Water, Bacterial Load, and Earthing consumption of water with a high mineral component produces alkaline by-products in the blood. Concentrations of TDS from natural sources have been found to vary from fewer than 30 mg/L (TDS, 30) to as many as 6000 mg/L (TDS, 6000), depending on the solubility of minerals in diferent geological regions.37 According to WHO criteria, the optimum pH of drinking water is oten in the range of 6.5 to 9.5. he principal constituents of TDS are usually cations— calcium, magnesium, sodium, and potassium; and anions— carbonate, hydrogencarbonate, chloride, sulfate, and nitrate.38 Natural mineral water difers from other bottled waters by its speciic geological underground origin; it has a stable composition of minerals and original purity.39 Natural mineral water must be bottled at the source to avoid any alteration in its chemical properties. Alkalinizing mineral waters can inluence the acid-base equilibrium of the body by which even small changes in pH can have signiicant efects on cellular function.40 In previous studies, higher TDS concentrations in drinking water were associated with a lower incidence of coronary heart disease (CHD),41 arteriosclerotic heart disease,42 cardiovascular disease (CVD),43,44 and cancer.45 Lower total-mortality rates have been reported with higher TDS levels in drinking water.44,46 A meta-analysis of case-control studies also found signiicant evidence for an inverse association between magnesium levels in drinking water and cardiovascular mortality.47 A review by Monarca et al48 investigated all of the articles that had been published from 1980 to 2003. It demonstrated an inverse association between water hardness and mortality from CVD. It has shown that most case-control studies and one cohort study have revealed an inverse relationship that is statistically signiicant between mortality from CVD and levels of magnesium, but not calcium, in the water.48 Another recent study also suggested favorable protective efects against CVD for water hardness, mainly due to the content of magnesium in the water.49 Information from epidemiological and other studies supports the hypothesis that a low intake of magnesium may increase the risk of dying from, and possibly of developing, CVD or stroke. herefore, not removing magnesium from drinking water (eg, by RO) or in certain situations, increasing the magnesium intake from water, may be beneicial, especially for populations with an insuicient dietary intake of the mineral.50 On the other hand, the British Regional Heart Study revealed that neither high water hardness nor high calcium nor magnesium intake appreciably protected participants against CHD or CVD.51 Another study in the Netherlands also found no evidence for an overall signiicant association between tap-water hardness or magnesium or calcium concentrations and mortality from ischemic heart disease (IHD) or stroke.52 An inverse or protective association between water hardness and cardiovascular mortality has been reported in most, but not all, previous studies. No supporting evidence exists concerning a higher rate of renal disease or stone formation with use of water high in ALTERNATIVE THERAPIES, VOL. 22 NO. S1 27 TDS. Water containing excess calcium is tightly regulated by the mechanism of intestinal absorption and elimination, except for those individuals with milk alkali syndrome or hypercalcemia, whereas a higher intake of magnesium is of concern for people with renal insuiciency.53 On the contrary, water with a high magnesium level has been found to be associated with a lower incidence of urinary calculus.54 Further, mineral water with a higher calcium content has been shown to induce higher calcium excretion but signiicantly decreased oxalate excretion. No deinite evidence exists that hard water is more lithogenic than sot water.55 Epidemiologic evidence has shown that higher calcium intake is associated with lower recurrence rates of calcium-oxalate stones. hat result is likely explained by calcium’s inhibition of absorption of intestinal oxalate.56 Consequently, water with a high calcium constituent reduces calcium-oxalate stone formation. Mineral-water consumption could be a simple and inexpensive approach for osteoporosis prevention and could be of major interest for long-term prevention of bone loss.30 Mineral waters have a beneicial efect on bone metabolism that has mainly been attributed to their calcium content.57-59 Calcium-rich mineral waters have been shown to be an alternative to dairy products as the calcium bioavailability is similar or possibly even better.60 he minerals in alkaline water together with the HCO3- also seem to play an important role in decreasing bone resorption and increasing BMD.61,16 In a study that included 30 female dieticians aged 26.3 years (SD, 7.3), it was also revealed that alkaline mineral water can signiicantly reduce bone resorption, whereas acidrich calcium water had no efect on bone resorption.62 Wynn et al63 concluded that the best waters for bone health are rich in both HCO3- and Ca, and low in SO4. Supplementation with electrolyzed, reduced water (ie, alkaline ionized water) might provide an antioxidant defense mechanism in pancreatic beta cells, a inding that was revealed in mice that were experimentally induced with diabetes64 and that showed an improved blood-glucose control. hat result could have occurred due to enhanced insulin sensitivity as well as increased insulin release. hose results suggest that electrolyzed, reduced water may function as an orally efective, antidiabetic agent. REDUCTION OF ACIDS AND TOXINS PRODUCED BY DIGESTIVE TRACT BACTERIA Bacterial overgrowth is most prominent in the upper digestive tract (ie, the mouth and pharynx) and in the terminal portion (ie, the large intestine), whereas the middle part (ie, the stomach and small intestine) contains far fewer microbes as the result of highly acidic or highly alkaline media. herefore, unhealthy teeth or gums and bad oral hygiene may play a signiicant role in producing an acid load in the blood stream, which is formed by oral and pharyngeal microorganisms. hose changes might be the cause of a relationship between bad oral hygiene and CVD. 28 ALTERNATIVE THERAPIES, VOL. 22 NO. S1 he human gut’s microorganisms contribute 36% of the small molecules that are found in human blood, and the gut also plays a major role in creating a susceptibility to certain human diseases.65 he microbial population colonizing the human intestinal tract includes a number of aerobic and anaerobic bacteria that produce one or more toxins. hose toxins have been shown to have the ability to penetrate intestinal cells ater their binding to speciic surface receptors.66 In the absence of respiration or photosynthesis, bacteria are entirely dependent on substrate phosphorylation for their energy. Many compounds can serve as fermentable growth substrates, and many pathways for their fermentation have evolved. For example, glucose fermentation produces either lactic acid or ethanol and carbon dioxide (CO2). he end product of bacterial fermentation results in acidiication of the surrounding medium.67 hus, acids and toxins retained in the digestive tract can leak into the surrounding tissues and the blood, afecting the whole body’s systems. A meta-analysis of observational studies revealed that participants with periodontal diseases have higher odds and higher risks of developing CVD.68 A study including 104 patients of both genders, aged 50 to 90 years, showed a relationship between the bad condition of the oral cavities of the patients and hypertension and, speciically, fresh myocardial infarctions.69 It has also been found that dental disease is associated with an increased risk of CHD, particularly in young men.70 Moreover, bacterial overgrowth with high acid production may result from improperly digested food. hat could happen if large food particles arrive in the large intestine of people who have problems with chewing or who insuiciently chew food and/or who eat fast. he digestion in the stomach may also be afected by drinking a large quantity of water during or immediately ater a meal, which could result in dilution of stomach acids and enzymes. Overeating ater fullness also may surpass the digestive system’s abilities, which might lead to the escape of some undigested food into the large intestine. In addition, when an individual eats some food only a short period ater eating a main meal, approximately 30 minutes, the stomach is still in the process of evacuating that irst entirely digested meal. Eating again could lead to mixing digested and undigested foods, which are then pushed toward the duodenum. Eating while not hungry or during a satisfaction state may also afect digestion as a result of insuicient production of saliva and/or digestive enzymes. Intended, delayed bowel evacuation or not emptying the bowel before bedtime might play same role in producing high acids and toxins. herefore, it is advisable to evacuate the bowel as soon as possible ater feeling the urge for propulsion. Fast eating can deinitely lead to insuicient food chewing. It has been noticed that a possible relationship exists between faster eating speeds and the increased risk of type 2 diabetes mellitus.71 Teeth lossing by threads or wooden or plastic sticks, which removes food particles and plaques that breed bacteria, also can reduce acid production in the mouth cavity. Mousa—Alkaline Diet and Water, Bacterial Load, and Earthing A recent study suggested that lossing and brushing of interdental spaces might reduce the risk for new cardiovascular events among patients with CHD.72 A cycle could happen in a sequential and cumulative pattern as follows—poor oral hygiene, gum disease, teeth plaques, teeth carries, teeth loss, and, inally, inefective chewing. In a large cross-sectional study, Holmlund et al73 reported a relationship between an increased risk in the self-reported history of antihypertensive treatment and the number of diseased periodontal pockets as well as a linear trend between periodontal-disease severity and antihypertension treatment. he presence of periodontal disease has also been found to be associated with metabolic syndrome, suggesting that preventing periodontal disease may prevent metabolic syndrome.74 In addition, a meta-analysis revealed that periodontal disease appears to be a possible risk factor for pre-eclampsia.75 Earthing (Grounding) Earthing or grounding is connecting the human body to the earth in diferent ways. It could be performed by walking with bare feet or by connecting the body using an apparatus that provides a conductive system to the earth. he body could be earth-grounded by means of a conductive patch or earthing sleep system on a bed’s mattress that is connected to a building’s earthing system. It is recommended to connect the body with the earth directly or naturally, away from electrical interference from the building’s systems or from electrical stations (ie, by a connection that is free from electric ields). It has been established that the earth’s surface possesses a limitless and continuously renewed supply of free or mobile electrons. he surface of the planet is electrically conductive, except in limited, very dry areas such as deserts, and its negative potential is maintained (ie, its electron supply is replenished) by the global atmospheric electrical circuit.76,77 Until a few generations ago, most humans walked and slept in direct contact with the surface of the earth. Our modern lifestyle involves wearing insulating shoes and sleeping in buildings that electrically isolate the body from the ground plane.78 It has been proposed that free or mobile electrons from the earth could resolve chronic inlammation by serving as natural antioxidants.79 It is assumed that the inlux of free electrons absorbed into the body through direct contact with the earth likely neutralizes free radicals and, thereby, reduces acute and chronic inlammation.80 he inlammation theory connects chronic disease with a situation that is describable in electronic or energetic terms. A free radical is a molecule that is missing an electron. Its destructive efects are explained in terms of the rapid and violent reactions taking place as electrical charges are redistributed between the reacting molecules. he violent reactions are the breaking of chemical bonds that are responsible for the integrity of the cell walls of bacteria, cell membranes, DNA, damaged connective tissue, and other structures.79 he continuous earthing of the human body has revealed a reduction in blood glucose in patients with Mousa—Alkaline Diet and Water, Bacterial Load, and Earthing diabetes, whereas earthing for a single night has been shown to reduce the primary indicators of osteoporosis.81 Earthing has been found to increase the zeta potential of red blood cells (RBCs) and to reduce RBC aggregation signiicantly. he zeta potential is a parameter closely related to the number of negative charges on the surface of an RBC. he higher the number is, the greater is the ability of the RBC to repel other RBCs. herefore, the greater the zeta potential is, the less coagulable is the blood. Earthing has been shown to increase the surface charge on RBCs and thereby, reduce blood viscosity and clumping.82,83 It has been concluded that earthing could be one of the simplest, and yet most profound, interventions for helping reduce cardiovascular risk and cardiovascular events. Earthing also has produced (1) symptomatic improvements in sleep disturbances and chronic muscle and joint pain84; (2) the restoration of normal, day-night, cortisolsecretion proiles85; (3) a reduction in the electric ields that are induced by AC current on the body86; (4) a reduction in overall stress levels and tensions78; (5) an increase in parasympatheticsystem function and/or a reduction in sympathetic-system function87; (6) a speeding of recovery from delayed-onset muscle soreness ater exercise88; (7) an improvement in heart rate variability89; and (8) an improvement in immune response.88 In a recent double-blinded study, grounding for 1 hour improved positive moods signiicantly as compared with the moods of participants who were not grounded.90 In that study, earthing produced better mood improvement than was experienced through relaxation alone. In cases of experimental injury to the muscles of animals (ie, delayed-onset muscle soreness) grounding reduced pain, altered the numbers of circulating neutrophils and lymphocytes, and also afected various circulating chemical factors related to inlammation.91 It produced measurable diferences in the concentrations of white blood cells, cytokines, and other molecules involved in the inlammatory response. he length of time and degree (ie, the resistance to ground) of grounding is an important factor that can inluence the outcomes of inlammation and wound healing.91 From a historical perspective, American Indians have had a great belief in the healing power of the earth. hey have a custom in which they bury suferers from all kinds of disease in the earth up to their necks, leave them there for some hours, and then remove them. A mud bath is also valuable in obtaining relief from rheumatic pain or pain in the joints caused by injuries, whereas mud packs can also bring down fever and have been shown to be beneicial in the treatment of scarlet fever, measles, and inluenza.92 It is now recognized that an overwhelming inlammatory response is the cause of human deaths from infection with the avian H5N1 inluenza.93 In previous studies, earthing has demonstrated its anti-inlammatory efects80,91 and improvements in the immune response88 where both efects have been essential for inluenza cure. No studies have been found that investigate the efect of earthing in inluenza treatment. Future studies are suggested to reveal the efects of grounding for such treatment. ALTERNATIVE THERAPIES, VOL. 22 NO. S1 29 SUMMARY Supporting evidence exists that an alkaline diet and alkaline water with suicient protein intake can support bone mineralization, whereas consumption of excess fruits, vegetables, and alkaline water has shown a signiicant promotion of health, especially for people at an older age (Figure 1, Table 2). With advanced age and reduced renal capacity, the tendency for people to sufer from low-grade acidosis increases, which might explain the rapid, overall health deterioration that comes with greater age. With metabolic acidosis, the body’s ability to excrete toxins also declines. To overcome those defects, it is recommended that people consume foods that are higher in alkaline substances and alkaline water as well as avoid an acidic diet and acidic water (ie, water low in minerals) as they grow older. People in some countries have been collecting rainwater for drinking purposes, and, thereater, the rainwater is stored in containers that are not tightly closed, which tends to cause it to absorb carbon dioxide from the air. hat procedure results in a gradual lowering of the pH due to the formation of a weak carbonic acid. hrough that process, the water can get as low as 5.5 on the pH scale, with no minerals, which could have harmful health efects. hrough the natural water cycle ater rain, water has to be mixed with soil to obtain essential minerals. It is recommended that people drink water from mineral-rich alkaline springs or rivers and avoid RO water. RO water contains an insuicient amount of essential minerals. Water containing high levels of calcium and magnesium is associated with a lower incidence of urinary-tract stone formation. Figure 1. Natural Factors With Health-enhancement Efects Health Promotion Factors Alkaline Diet Alkaline or Mineral Water • Create healthy bones • Induce higher osteoblast activity • Encourage higher bone mineralization • Preserve muscle mass • Reduce tumor invasiveness and metastasis • Enhance toxin excretion • Reduce CHD • Reduce arteriosclerotic heart disease • Reduce CVD • Reduce cancer incidence • Lower total mortality rates • Prevent osteoporosis • Protect pancreatic β cells Earthing or Grounding • • • • • • • • • • • • • Reduce chronic inlammation Reduce blood glucose Reduce osteoporosis indices Reduce RBC clumping Reduce blood viscosity Reduce blood coagulation Reduce cardiovascular events Improve sleep Improve chronic muscle and joint pain Speed recovery from muscle soreness Reduce stress levels Improve immunity Improve positive moods Abbreviations: CHD, coronary heart disease; CVD, cardiovascular disease; RBC, red blood cells. Table 2. Detrimental Health Efects of an Acidic Diet and Acidic or Low-mineral Water Acidic Diet Bone resorption12,13,15,16,19,20,21,22,23,24,25,27,29,30 Muscle-mass-preservation defect29,32,33 Tumor invasion and metastasis34 Inefective toxin excretion35 30 ALTERNATIVE THERAPIES, VOL. 22 NO. S1 Acidic or Low-mineral Water Bone resorption16,30,57,58,59,61,62 Higher coronary heart disease41 Higher arteriosclerotic heart disease42 Higher cardiovascular disease43,44,47,48,49,50 Higher stroke50 Higher cancer45 Higher total mortality44,46 Mousa—Alkaline Diet and Water, Bacterial Load, and Earthing Figure 2. he Inluence of the Bacterial Load in the Digestive Tract on Overall Health Reduction in the bacterial load • Mouth is free of periodontal disease • Flossing occurs • Perfect chewing occurs • Early bowel evacuation occurs Increase in the bacterial load • Mouth shows periodontal disease • Fast eating occurs • Overeating occurs • Bowel evacuation is delayed Reduced acid and toxin load Increased acid and toxin load Alkaline-source efects + Higher ability to excrete toxins from the body Acidic-source efects + Lower ability to excrete toxins from the body Health-promotion efects Detrimental health efects Flossing teeth ater each meal is necessary to reduce bacterial-acid production from the mouth’s buccal cavity. Large-bowel emptying should be performed as soon as possible ater feeling fullness or any urge for evacuation. Delayed bowel evacuation could result in prolonged body contact, especially during sleep, with acids and toxins, which are byproducts of bacteria. Overeating, fast eating, and imperfect food chewing may produce bacterial overgrowth in the digestive tract, with overproduction of acids and toxins that are absorbed into the bloodstream (Figure 2). Some studies have indicated that the human body’s direct contact with the earth could have several favorable health efects, including anti-inlammatory efects, relief of muscle and joint pain, immunity reinforcement, provision of antioxidants, prevention of bone resorption, blood-glucose reduction in diabetics, anticoagulatory efects, sleep improvement, and positive mood enhancement. immunity, improve mood, reduce blood viscosity, and many other beneicial efects. CONCLUSIONS Favorable health efects could be obtained by consumption alkaline diets, which are rich in fruits and vegetables, and drinking alkaline mineral water. Reduction in the bacterial bulk of the digestive tract could also prevent many chronic degenerative diseases. Earthing or grounding proved to be efective as anti-inlammatory, enhance Mousa—Alkaline Diet and Water, Bacterial Load, and Earthing AUTHOR DISCLOSURE STATEMENT he author has received no inancial support for the current review that could have inluenced its outcome. he author declares that he has no conlicts of interest. REFERENCES 1. Paulev PE, Zubieta-Calleja GR. Essentials in the diagnosis of acid-base disorders and their high altitude application. J Physiol Pharmacol. 2005;56(suppl 4):155-170. 2. Gluck SL. Acid-base. Lancet. 1998;352(9126):474-479. 3. Frassetto L, Morris RC Jr, Sellmeyer DE, Todd K, Sebastian A. 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