“…Our 4 cases of hepatotoxicity related to consumption of “Real Water” are the first reported cases in the literature. Although not the first reported cases of hepatitis because of drinking water (2), our cases are unique in describing hepatotoxicity related to manufactured alkaline drinking water. Alkaline drinking water has increased in popularity as a health fad based on the acid-ash hypothesis, which proposes a diet rich in alkali to achieve a neutral body pH and allow for potential health benefits, such as decreased bone erosion (3) or tumor development (4).…”