Alkaline Water for LPR and Acid Reflux: Does It Help and What pH Do You Need?

If you have LPR (silent reflux), alkaline water is one of the most useful things you can add to your daily routine — not because it treats the root cause, but because of something very specific it does to pepsin. Once you understand that, the case for drinking it is pretty clear.

This article covers why it matters for LPR specifically, what the research actually shows, how to use it properly and what to look for when choosing one.

Key Takeaways:

• Alkaline water with a pH of 8.8 or above permanently deactivates pepsin — the enzyme responsible for most LPR throat damage
• This is confirmed by a peer-reviewed study by Dr. Jamie Koufman and Dr. Nikki Johnston (2012) published in the Annals of Otology, Rhinology and Laryngology
• Regular tap and bottled water (typically pH 6.7 to 7.4) does not deactivate pepsin — only water at pH 8.8 or above has this effect
• Alkaline water is most effective when used alongside a low acid diet and Gaviscon Advance — not as a standalone treatment
• The best options are naturally alkaline spring water or filtered alkaline water — ideally pH 9 or above
• Stop drinking alkaline water 48 hours before a Peptest — it will deactivate pepsin in saliva and affect your results

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Why Alkaline Water Matters for LPR — The Pepsin Connection

To understand why alkaline water is useful for LPR you need to understand what’s actually causing the symptoms — because it’s not just the acid.

When you reflux with LPR, stomach acid carries a digestive enzyme called pepsin up into the throat and voice box. Pepsin is normally there to break down protein in the stomach — when it gets into the throat it starts doing the same thing to your throat cells, causing inflammation and damage. This is what produces most of the symptoms people with LPR experience — the chronic cough, the hoarseness, the globus sensation, the throat clearing.

Here’s the crucial part: pepsin can sit dormant in your throat cells for up to 24 to 48 hours after a reflux episode. It doesn’t disappear. It waits. And if anything acidic comes into contact with your throat during that time — food, drink, even another reflux event — the pepsin gets reactivated and causes more damage all over again. This is why LPR can feel relentless even when you’re being careful.

Alkaline water breaks this cycle. Water at pH 8.8 or above doesn’t just neutralise acid — it permanently deactivates pepsin, stopping it from causing any further damage. This is different from what regular water does. Tap water and most bottled water sit between pH 6.7 and 7.4, which is not alkaline enough to affect pepsin at all.

You can read more about how pepsin works and why it matters in my complete guide to LPR.

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What the Research Shows

The key study here is one by Dr. Jamie Koufman and Dr. Nikki Johnston (2012), published in the Annals of Otology, Rhinology and Laryngology. This was a laboratory study that specifically tested whether alkaline water at pH 8.8 could inactivate human pepsin.

The findings were clear: pH 8.8 alkaline water instantly and irreversibly denatured human pepsin, rendering it permanently inactive. The same water also showed far superior acid-buffering capacity compared to conventional bottled waters at neutral pH. The researchers concluded that alkaline water consumption may have genuine therapeutic benefits for people with reflux disease.

Notably this research was co-authored by Dr. Nikki Johnston — the same researcher now developing fosamprenavir as the world’s first pepsin inhibitor for LPR. Both approaches are targeting the same thing from different angles — and alkaline water is the dietary version of the same principle.

The Zalvan et al. JAMA study (2017) comparing a plant-based Mediterranean diet and alkaline water against PPI therapy found that the dietary approach — which included alkaline water as the primary beverage — produced comparable symptom improvement to PPIs in LPR patients. That’s a significant finding. It suggests alkaline water as part of a broader dietary approach can match pharmacological acid suppression for LPR.

More recently, clinical writing from Koufman’s team has emphasised that pH 9.5 or above is the optimal target — the higher the pH the more effectively pepsin is deactivated. pH 8.8 is the confirmed threshold, but aiming higher gives you more margin.

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How to Use Alkaline Water for LPR

The most effective way to use alkaline water for LPR is to make it your default drink throughout the day, use it after anything acidic, and drink it first thing in the morning before anything else. Here’s why each of these matters.

Make it your main water throughout the day. The goal is to keep the throat environment consistently alkaline — not just drink it occasionally. Every time you reach for regular water at pH 6 to 7 when you could be drinking alkaline water, you’re missing a chance to neutralise dormant pepsin. I switched to alkaline water as my only water and noticed the difference within a couple of weeks.

Use it after anything acidic. If you eat or drink something slightly acidic — even something within the LPR-safe range — following it immediately with alkaline water helps neutralise residual acidity in contact with the throat. Think of it as a rinse that resets the environment each time.

First thing in the morning is particularly valuable. After 7 to 8 hours lying down there’s a reasonable chance some reflux has occurred during sleep. Making alkaline water the first thing that touches your throat in the morning helps deal with any pepsin that’s settled there overnight. This is one of those habits that genuinely makes a difference.

Stop it 48 hours before a Peptest. Alkaline water deactivates pepsin so effectively that it will skew your Peptest results if you drink it before the sampling window. Switch to regular water at least 48 hours before collecting samples. More on this in my Peptest review.

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What pH Do You Need?

For alkaline water to deactivate pepsin and help LPR, it needs to be at least pH 8.8 — and ideally pH 9 or above. This is the threshold confirmed by the Koufman and Johnston study. Below pH 8.8, including all standard tap water and most bottled water, there is no meaningful effect on pepsin.

In practice, aim for pH 9 or above. This gives you a comfortable margin above the 8.8 threshold and means even if the pH drops slightly after opening (which it can), you’re still in the effective range.

pH 10 or above is generally the upper end you’d want to drink regularly. Very high pH water over extended periods isn’t something that’s been studied long-term, and there’s no established benefit to going far beyond what’s needed to deactivate pepsin.

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Your Options for Getting Alkaline Water

There are four main ways to get alkaline water for LPR, ranked here from best to least ideal. The short version: naturally alkaline spring water is the gold standard, quality filtered alkaline water is a more affordable daily option, drops are fine for travel, and baking soda works as a short-term fix only.

1. Naturally alkaline bottled spring water — the best option

Naturally alkaline water — where the pH comes from minerals occurring naturally in the water source rather than from anything added — is the best choice. This is what the Koufman study actually used: Evamor, a naturally alkaline artesian water at pH 8.8. Natural bicarbonate in the source water is what creates the alkalinity.

Look for the pH stated on the label. If it doesn’t state a pH it’s unlikely to be meaningfully alkaline. Common options in the UK and US with confirmed higher pH include:

• Evamor — naturally alkaline artesian water, pH 8.8 (the specific water used in Koufman’s study)
• Essentia — ionised water, typically pH 9.5
• Flow — naturally alkaline spring water, typically pH 8.1
• Icelandic Glacial — naturally alkaline, pH around 8.4

One important caveat: the pH stated on the label is the pH at source. Once bottled and transported, pH can drop somewhat. The only way to know the actual pH of what’s in the bottle is to test it yourself with a pH meter or pH strips. I’d recommend testing before committing to a brand — it’s a small investment that pays off if you’re buying regularly.

2. Filtered alkaline water — a cost-effective alternative

Alkaline water filter pitchers and under-sink systems raise the pH of regular tap water through a mineral filtration process. They’re significantly cheaper long-term than buying bottled water daily and the quality ones consistently produce water at pH 9 to 9.5.

Look for filters that use a multi-stage process including mineralisation — this is what raises the pH naturally rather than just through electrolysis. Brands like Santevia and AlkaViva are generally well-regarded.

3. Alkaline water drops — a portable option

You add a few drops to regular water to raise the pH. The quality varies significantly between brands and the pH increase is less consistent than filtration or naturally alkaline water. Worth using when travelling or when you don’t have access to your usual option, but not my first choice for daily use.

4. Baking soda in water — works but not ideal long-term

Half a teaspoon of baking soda in water raises the pH significantly and does work to neutralise acid and pepsin. The problem with using it regularly is the sodium content — it’s high in salt which is a concern if you’re drinking it multiple times a day. Fine as an occasional option but not something I’d use as your primary source of alkaline water long-term.

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Should You Test the pH Yourself?

Yes — and it’s worth doing. A basic digital pH meter costs around £10 to £20 / $15 to $25 and takes the guesswork out of it entirely. The pH on the label is the pH at source — once bottled and transported it can drop, sometimes significantly. The only way to know what’s actually in the bottle is to test it.

I’d recommend testing any water you’re planning to drink regularly for LPR. If it comes back at pH 7 or below, it’s not doing what you need. Calibrate the meter before use with the calibration solution that comes with it and test at room temperature for the most accurate reading.

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Is Alkaline Water Enough on Its Own?

No — alkaline water on its own is not enough to treat LPR. It deactivates pepsin already in the throat but does nothing to stop more pepsin from refluxing up. If the diet and Gaviscon Advance aren’t in place alongside it, you’ll be chasing your tail.

I’ve seen people drink alkaline water religiously and still struggle because they haven’t addressed the root cause. The water is doing its job — but new pepsin keeps arriving faster than it can be neutralised. That’s why the combination matters.

The combination that actually works is:

• The low acid diet — stops pepsin from being reactivated by acidic food and drink
• Gaviscon Advance (UK version) — creates a physical barrier that prevents reflux reaching the throat
• Alkaline water — deactivates any pepsin that does reach the throat, and keeps the throat environment alkaline

Used together, these three things address the problem from three different angles. Alkaline water is a meaningful piece of that — it’s just not the whole picture on its own. For the complete treatment approach check my silent reflux treatment guide.

If you want a fully structured plan that tells you exactly what to eat, what to drink and how to combine these approaches, check the Wipeout Diet Plan. And if you want personalised guidance for your specific situation consider a private consultation.

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Frequently Asked Questions

What pH does alkaline water need to be for LPR?

The research-confirmed threshold is pH 8.8 — this is where alkaline water permanently deactivates human pepsin, as demonstrated in Koufman and Johnston’s 2012 study. In practice, aim for pH 9 or above to give yourself a comfortable margin. Most tap and standard bottled water sits between pH 6.7 and 7.4 — not alkaline enough to affect pepsin.

Does alkaline water help GERD as well as LPR?

Yes — the Koufman study confirmed benefits for reflux disease generally, not just LPR. For GERD the acid-buffering capacity of alkaline water is the main benefit — it helps neutralise acid in the oesophagus. For LPR the pepsin deactivation is the more critical mechanism. Both benefit.

Can I drink too much alkaline water?

There’s no established harm from drinking alkaline water regularly at the levels needed for LPR management. The concern sometimes raised about disrupting stomach acid applies mainly to very high pH water consumed in very large quantities — normal drinking levels are not a concern. Your stomach produces its own acid regardless of what you drink and self-regulates effectively.

Is naturally alkaline water better than ionised or filtered alkaline water?

Naturally alkaline water — where the pH comes from naturally occurring minerals like bicarbonate in the source — is generally considered the better option. The Koufman study specifically used naturally alkaline artesian water. Ionised and filtered options can be effective but the quality varies more between brands. If using a filter, look for one that uses mineralisation rather than just electrolysis.

Will alkaline water interfere with my digestion?

Drinking alkaline water between meals and away from meals is unlikely to interfere with digestion. Drinking a lot of anything immediately before or during a meal can dilute stomach acid temporarily but this applies to any water. The practical advice is to drink alkaline water consistently throughout the day rather than in large amounts right before eating.

How does alkaline water fit with the low acid diet?

They work together. The low acid diet prevents dietary acids from reactivating dormant pepsin in the throat. Alkaline water actively deactivates that pepsin. Together they’re more effective than either alone — the diet stops reactivation, the water neutralises what’s there. You can read more about the dietary approach in my LPR diet guide.

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Conclusion

Alkaline water at pH 8.8 or above permanently deactivates pepsin and is one of the most practical additions you can make to an LPR treatment plan. The science is solid, the mechanism is clear, and it’s something you can implement today without a prescription or a specialist referral. The key points: minimum pH 8.8, ideally 9 or above, naturally alkaline or quality filtered, used as your default drink throughout the day.

Used on its own it won’t resolve LPR. As part of the right combination — low acid diet, Gaviscon Advance and alkaline water — it genuinely moves the needle.

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Related articles:

• The Complete Guide to LPR — Causes, Symptoms and Treatment
• LPR Diet — What to Eat, What to Avoid and What to Drink
• LPR Foods to Avoid — The Complete List
• Gaviscon Advance for LPR
• Silent Reflux Treatment — What Actually Works
• How I Cured My Silent Reflux
• Peptest Review — Is It Worth Doing?
• What Can You Drink with Acid Reflux?

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References

1. Koufman JA, Johnston N. (2012) “Potential benefits of pH 8.8 alkaline drinking water as an adjunct in the treatment of reflux disease.” Annals of Otology, Rhinology and Laryngology, 121(7):431-434. PubMed
2. Zalvan CH et al. (2017) “A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux.” JAMA Otolaryngology-Head and Neck Surgery, 143(10):1023-1029. PMC
3. Johnston N, Dettmar PW, Bishwokarma B, Lively MO, Koufman JA. (2007) “Activity/stability of human pepsin: implications for reflux attributed laryngeal disease.” The Laryngoscope, 117(6):1036-9. PubMed