Shares

This will be a brief post compared to my typical efforts, but one that highlights an important issue: the safety of bottled drinking water in the United States. Most of us drink bottled water, with many doing so every day. It is a convenient but expensive choice with the unfortunate environmental downsides of increased plastic waste and a larger carbon footprint, but one which I must admit that I make when I arrive at work most mornings.

I grab a bottle of sparkling water as I pass by the cafe near the entrance to my hospital because of convenience and a preference for bubbles, not because I’m worried about the water coming out of the drinking fountains. There is, however, a false belief held by many in America that tap water is less safe than the bottled variety, particularly among minority households. This is sadly understandable given the events that occurred in Flint a few years ago.

The market for these products is competitive and companies have developed a variety of shady promotional techniques in order to grab our attention. This often comes in the form of appeals to nature, with implications that natural spring water, for example, is somehow better than what comes out of the tap. But many bottled water products, despite pictures on the labels depicting pristine woodland creeks and snow laden mountain ranges, are sourced from municipal water supplies.

Bottled water marketed as “live” or “raw” is perhaps the worst example of this tactic. After all, what’s more natural than unfiltered water straight from the crick? (It has a lovely finish, and am I picking up a hint of bear shit?) But it’s all risk and no benefit with a hefty price tag. But don’t take my word for it.

Bottled water products also frequently contain additives such as vitamins and minerals, and are promoted with claims of health benefits beyond what would be expected from consuming plain water such as “ultimate powerful hydration” and “optimum health“. Smartwater, the popular Coca-Cola Company subsidiary and Golden Windbag award winner, along with many of their competitors, sells bottled water that contains antioxidants using the following marketing copy:

every drop of smartwater antioxidant tastes pure and will leave you feeling refreshed. it’s everything you want from a bottled water—pure, hydrating, and crisp.

it might be thanks to the fact that it’s vapordistilled through a process inspired by the clouds. or the fact that we’ve added electrolytes for taste and infused each bottle with antioxidant selenium. either way, you can bet on a premium water experience with every bottle.

healthy hydration for healthy living. smartwater antioxidant is a smart way to hydrate.

So many weasel words! It’s brilliantly designed to separate the worried and thirsty from their money using sexy buzzwords like “pure”, “premium”, “healthy”, and…”vapor-distilled”? Kidding aside, the geniuses at smartwater don’t need to make specific health claims which might run them afoul of regulatory agencies. They know that consumers will fill in the details and believe that somehow this product will improve the function of their immune system. It doesn’t, at least not any more so than regular tap water.

Another example of the kind of bogus health claims being used to promote some bottled water products is so-called “oxygen water”. These products claim to improve recovery from exercise or injury and to detoxify the body. But, as our own Scott Gavura explained in his post on this particular form of snake oil, you can’t breath through your stomach. And, kidding aside, even if a bit of extra oxygen were somehow absorbed through the GI tract it wouldn’t matter because it pales in comparison to the amount in a single breath.

Smartwater doesn’t stop with antioxidants, however. Like many other producers of bottled water, they also sell a line of alkaline waters. They avoid making any specific claims regarding health benefits from consuming their water, which is “ionized to 9+pH”, but others aren’t shy about going there despite a complete lack of basic science plausibility and legitimate clinical evidence.

One of these other brands is, or rather was, Real Water. Its Nevada-based manufacturer, Real Water Inc., claimed that their alkaline water could reduce blood glucose levels, lower cholesterol, improve metabolic function, treat acid reflux, increase longevity, improve bone health, and get rid of those pesky free radicals. And naturally, according to the manufacturer, it tasted amazing. But after allegedly killing a 60-year-old woman and some pets, and hospitalizing a bunch of people, including 5 kids, they were forced to shut down by the FDA in June:

The consumption of “Real Water” brand alkaline water was the only known common link between five cases of acute liver failure in children that occurred in November and December 2020 that was reported to the FDA in March. Since then, 11 additional cases of acute non-viral hepatitis in adults, including one death of a woman with underlying medical conditions, have been identified as possibly linked to the consumption of Real Water brand alkaline water.

So what happened? Real Water was Las Vegas municipal tap water that was filtered and processed with lye, potassium bicarbonate, and magnesium chloride. An investigation is underway, so details may change, but it appears that there was very little quality control. One former employee admitted to essentially just adding random amounts of chemicals to the water and the company was cited for “failing to develop a written food safety plan, to clean and sanitize equipment, to sample and test cleaning solutions, and to list all ingredients on bottles”. They were also observed by investigators using potentially toxic detergents and sanitizers to clean reusable containers that were sold to consumers.

Why was this allowed to happen? Sadly, the regulation of bottled water, under the jurisdiction of the FDA, is lacking. They talk a good game, however:

For bottled water production, bottlers must follow the (current good manufacturing practice) regulations put in place and enforced by FDA. Water must be sampled, analyzed, and found to be safe and sanitary. These regulations also require proper plant and equipment design, bottling procedures, and record keeping.

In addition, FDA oversees inspections of bottling plants. The agency inspects bottled water plants under its general food safety program and has states perform some plant inspections under contract. (Some states also require bottled water firms to be licensed annually.)

But here is the problem:

FDA protects consumers of bottled water through the Federal Food, Drug, and Cosmetic Act (FD&C Act), which makes manufacturers responsible for producing safe, wholesome, and truthfully labeled food products.

As with the regulation of dietary supplements and herbal remedies, the onus of proving that bottled water is safe is on the manufacturer. The FDA simply does not have the resources to do it themselves. Large companies with well known brands are unlikely to put out a dangerous product but there are many small and niche producers that come and go every year with less incentive to play by the rules. Unfortunately, again as with supplements and herbs, it sometimes takes people being harmed or even killed before the FDA steps in and shuts production down.

There are plenty of reasons to reduce bottled water consumption from an environmental perspective. I’m personally going to continue buying my favorite flavored seltzer at work, but I also refill a water bottle from my tap at home to bring to the gym for several weeks, cleaning it every few days, before buying a new one. When it comes to safety, I would recommend sticking to established brands and avoiding water that comes with health related claims other than quenching thirst and hydration, but not ultimate hydration, whatever that even means.

Shares

Author

  • Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.