Plain Carbonated Water Has No Verifiable Negative Health Effects
Plain carbonated water is explicitly recommended as a healthy, hydrating beverage option equivalent to regular water in major clinical nutrition guidelines, with no evidence of adverse health effects in healthy adults. 1
Distinction Between Plain and Sweetened Carbonated Beverages
The critical distinction is between plain sparkling water and sugar-sweetened or artificially-sweetened carbonated beverages:
Plain carbonated water contains no added sugars or artificial sweeteners and does not carry the metabolic or cardiovascular risks identified for sweetened carbonated drinks. 1
Sugar-sweetened carbonated beverages are linked with obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. 1, 2
Artificially-sweetened carbonated beverages are associated with a 36% increased risk of metabolic syndrome with daily consumption. 1
The American Heart Association recommends plain, carbonated, or unsweetened flavored water as alternatives to sugar-sweetened beverages. 3
Hydration Equivalence
The ESPEN hydration guideline states that sparkling water provides hydrating effects equivalent to plain water, based on randomized controlled trials in adult participants. 1
- The Dietary Guidelines for Americans advise that calorie-free beverages, including carbonated water, should be the primary beverage choice for the general population. 1
Gastrointestinal Effects: Myth vs. Reality
Despite common concerns, the evidence does not support negative gastrointestinal effects:
A systematic review found no direct evidence that carbonated beverages promote or exacerbate gastroesophageal reflux disease (GERD). 4
Carbonated beverages have not been consistently shown to cause GERD-related symptoms, oesophageal damage, or complications. 4
Carbonated water causes only a very short, transient decline in intra-oesophageal pH and may lead to temporary reduction in lower oesophageal sphincter pressure, but these effects are not clinically significant. 4
Gastric distress symptoms appear only when consuming more than 300 mL of carbonated fluid at once. 5
Carbonated water does not alter overall gastric emptying, though it modifies intragastric meal distribution by increasing retention in the proximal stomach. 6
Potential Benefits
Plain carbonated water may offer modest advantages:
Depending on the source, carbonated water can contribute 8-16% of the Recommended Dietary Allowance for calcium and 6-31% for magnesium per 2 L consumed. 1
Carbonated water induces a short-term satiating effect through enhanced postprandial gastric and cardiac activities. 7
Increased fullness scores were observed after carbonated water consumption compared to still water. 7
Common Pitfalls to Avoid
Do not confuse plain carbonated water with sugar-sweetened or artificially-sweetened carbonated beverages — the health risks associated with sodas do not apply to plain sparkling water. 1, 2
Tooth erosion concerns are minor with plain carbonated water and primarily related to acidic additives (citrus flavoring) or sweeteners, not carbonation itself. 5
The weak association between carbonated beverages and GERD in some surveys was based on inadequate methodology and contradictory evidence. 5, 4
Clinical Bottom Line
Based on current clinical nutrition guidelines, plain sparkling water should be recommended as a healthy, hydrating beverage option that adds variety to fluid intake without adverse health effects in healthy adults. 1 The American Diabetes Association and American Heart Association both emphasize water (including carbonated forms) as the preferred beverage choice over any sweetened alternatives. 3, 2