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hydrogen | Philosophy

We Know Enough About How H2 Works

Contributor Bio

Alex Tarnava is the CEO of Drink HRW, and the primary inventor of the open-cup hydrogen tablets. Alex runs the clinical outreach program for our company, working with over a dozen universities coordinating research. Alex has also published research of his own. You can find it on his ResearchGate. Additionally, he has been interviewed for many prominent publications, such as Entrepreneur and Forbes, and on many popular Podcasts. You can find all of his interviews and articles on his media page.

We Know Enough About How H2 Works

We Know Enough About How H2 Works

Let me clarify the title; we know enough about how H2 works to feel safe about using it as a supplement. No one in the know, from credible researchers to companies dedicated to understanding the science, suggests H2 should be used as a medicine, especially to substitute for existing, proven medications towards specific issues. Those currently marketing for this purpose are either woefully misinformed or con artists. Exacerbating the issue are those pushing hydrogen water therapy or in some cases, hydrogen inhalation for specific disease models as a miracle cure. These are typically companies and individuals selling products with inefficacious dosages and sometimes, even other known harms.

This is the conundrum in many industries and the issue goes quite deep and is multi-faceted. Opportunists, con artists, and some that are just plain ignorant/negligent will push products that don’t and can’t work to desperate populations. This brings considerable negative media attention, and the entire industry suffers, regardless of the industry. Simultaneously, the good actors struggle to resonate with audiences in the same capacity that the con artists do, due to lack of promises. Humans, specifically desperate individuals, are terrifyingly susceptible to promises of magical cures or aides.

As I write about in my articles coming out shortly “Are Supplements Regulated” and “Why an NDI matters”, the supplement industry is quite regulated, but there are significant issues, regardless of the country. A big issue is backlogs and resources. To be compliant is expensive. It over doubles our cost of goods to be compliant across numerous departments. It becomes further infuriating that competitors are almost never compliant, to file petitions against their illegal and sometimes potentially dangerous activities is expensive, and even after petitioning agencies to act, they may not possess the man power or resources as they have “bigger fish to fry”.

Many skeptics will point to gaps in understanding or lack of replication, even in regards to molecular hydrogen therapy and specifically hydrogen water, and decry that it shouldn’t be sold until we understand it better and it is investigated more thoroughly. Even after noting that there is replication in some areas, most notably athletic performance and metabolic impairments and it is overwhelmingly safe with a growing body of evidence, skeptics will fall back on “we don’t understand the mechanisms of action, so it shouldn’t be marketed until we understand it better.” I discuss this in greater detail in my article “Hydrogen and Skepticism”.

I find this position to be incredibly flawed both in logic and application. First off, opportunists, conmen and the ignorant/negligent have absolutely no care about the cries of foul play from skeptics. Further, those willing to engage said skeptics are typically the ones who understand the issues and are trying to market in a reasonable, accurate, and ethical manner. The companies going to this effort to champion a technology or product to skeptics in a truthful manner also more often than not have empirical evidence backing or validating said product. “The enemy of my enemy is my friend” rings true in this scenario. Both the skeptics and companies with integrity are enemies of the conmen, however in many cases, they end up at odds and hostile with one another. Skeptics will unfairly conflate the messaging or products of companies with integrity with those companies and individuals promising magic to the desperate, aiming to throw the baby out with the bath water, so to speak.

Only influence, through truthful and accurate messaging, repeated endlessly can fight the battle against false information. Hydrogen research isn’t stopping or even slowing down, it is growing at a rapid rate. Skeptics should embrace honest companies marketing modestly and truthfully, as they are a driving force to turn the tide and overwhelm the scourges of conmen and opportunists. Besides, the final points of skepticism that are sticking points with skeptics, the lack of replication and incomplete understanding of mechanisms of action, are irrelevant. The issues where we do not have approved treatments, such as prediabetic, reversible metabolic conditions, and exercise performance and recovery, have been replicated to a significant degree. Further…

We Don’t Know the Reason Many Drugs Work

It may come as a surprise to many readers that we lack understanding in how many popular, long-approved drugs work. We just know they work. As written in the Washington Post:

“Here’s how we think we discover powerful new medicines: Scientists dig deep into biology and zero in on a molecular Achilles’ heel that could disable a devastating disease, be it cancer or an infection. They concoct experimental drugs that hit the target. Then they conduct trials to find one that is safe and effective in people.

Here’s how we actually develop a surprising number of treatments: good old-fashioned observation, trial and error, and luck. Detailed scientific understanding of how a drug works often comes, ironically enough, near the end of the process.”

What are some popular drugs with elusive mechanisms of action, even today?

Acetaminophen (Tylenol)

For the probably 0 users who haven’t heard of acetaminophen, paracetamol, or the trade name “Tylenol”, it is a weak anti-inflammatory with potent analgesic effect, commonly used as an over the counter painkiller or to reduce fevers. Regarding its mechanisms of action, (from Wikipedia)

Despite its common use, the mechanism of action of paracetamol is not completely understood.”


Lithium, an element, is commonly used as a prescription drug for a variety of issues. Famously, it has saved countless lives for its mood stabilizing properties in those suffering from bi-polar disorder. Regarding this powerful and life saving therapy, we don’t know how it does this. We just know it works. From Wikipedia:

The specific biochemical mechanism of lithium action in stabilizing mood is unknown.

As I wrote about in my recent blog on getting out in nature, a big reason why it is important to aim for small victories for your mental health, especially if you suffer a mental illness, is that finding the right drug is often guess work. One drug, whether it be an antidepressant or antipsychotic, may work miracles for one person, but not only be inefficacious but come with serious side effects for another. The need for our system to dive deeper into personalized medicine based on our genetic make up, microbiota, and other factors is significant; luckily, it is coming. 


While we’ve long known how penicillin works, and its discovery and utilization has saved more lives than likely anything else, we are still discovering more about what it does and how it works many decades later. After 75 years of use, just a few years ago we discovered further mechanisms in how it operates.

In looking for skeptics to decry the use of the above three drugs based on lack of full understanding of the pharmacodynamics, little to nothing can be found. I understand the flaw in this argument. By playing this card, it opens the door for many proponents of technologies and therapies with no basis in reality to chime in with the same line “just because science doesn’t know how it works yet, doesn’t mean it doesn’t”. That’s why it is important to clarify we don’t need to know exactly how it works, we just need to know enough of how it works, and that it does seem to work in randomized, placebo-controlled trials. The latter distinctions effectively reduce the arguments of those peddling magic to meaningless.

Why it Doesn’t Matter with H2


I covered the safety of hydrogen gas in my article on hydrogen as a form of hormesis,

We know that molecular hydrogen can start creating narcotic-like effects at very high doses under high pressure through data from mixed sea diving.clxviii However, it has been shown only to happen at doses higher than even nitrogen,clxix which we know has a high safety threshold as it makes up 78% of our atmosphere.clxx Furthermore, molecular hydrogen has been shown to suppress some of the neurological symptoms of high pressure nervous system symptoms, even when hydrogen narcosis is present, providing another benefit in deep sea diving.clxxiclxxii

The dosage of hydrogen needed under pressure to exhibit signs of narcosis is significantly higher than any commercial method could potentially deliver to consumers. Thus, hydrogen narcosis (which exhibits no known long-term damages, toxicity or side effects), is of relatively small concern.

In clinical research, we have yet to determine an upper limit in therapeutic dosages of molecular hydrogen, especially hydrogen water which is particularly difficult to create with new research emerging showing very promising results from methods, such as our hydrogen tablets, which deliver the highest dosages on the market.

While other hormetic stressors need to be monitored to prevent them from becoming harmful, the safety of molecular hydrogen is extremely high. We know that alcohol has a very sharp J-shaped curve, with benefits in a tight range, and harm and damage following very closely after.”

On top of what I wrote above, in 70+ human trials on hydrogen, some lasting a year or more, the only noted side effects have been a slight mobilization of bowel movements and increased urination, the latter potentially due to an increase of drinking water as roughly 40% of the studies utilized hydrogen water, the remainder using inhalation or saline administration. Further, we endogenously produce several liters of hydrogen gas a day via bacterial breakdown of carbohydratesi, so we know that hydrogen isn’t foreign to us. This isn’t to say that potential safety concerns regarding hydrogen water are impossible, particularly to very specific issues in small subsets of the population, only the future knows. This is the case for virtually everything. For now, the safety evidence of molecular hydrogen, whether it be hydrogen water or inhalation, is as good as it can possibly be.


What We Know

Just as the drugs discussed above, we know some of how hydrogen works. We know it alters gene expression, showing thousands of changes throughout research, and we know it works via cell signal transduction. We know, for instance, it activates the Nrf2 pathway amongst many others, and we know it regulates production of pro-inflammatory cytokines. We know that it’s shown to both increase and suppress oxidative stress, model depending, but seems to only reduce the nastiest free radicals, such as the hydroxyl and peroxynitrite. Likewise, molecular hydrogen has shown to both activate and inhibit autophagy.

We know molecular hydrogen therapy has shown a potential benefit in over 170 disease models across every organ in the mammalian body through 1200+ publications and 70 human trials in 12 years of research. Just as many papers have been written on the pharmacodynamics of the drugs mentioned above, despite exact mechanisms of action being elusive, or new mechanisms being recently discovered, much has been written on the mechanisms of action of hydrogen gasiiiiiivvvivii. We at Drink HRW are actually active in supporting research set to begin to further dive deep into the mechanisms of action. We want to know more and understand that the more we know, the better we can utilize this molecule. That said, we know enough already to confidently advise for its everyday or intermittent use.

Hypotheses on Mode of Action

As I wrote about in my article on hydrogen and hormesis, it has recently been hypothesized that H2 works as a form of hormesis. While this hypothesis is attractive and makes sense from the alterations we see from drinking hydrogen water or other forms of hydrogen therapy and directly comparing them to the biological outcomes from other forms of hormesis, we don’t know why hydrogen is a stress. We don’t know what is direct and what is indirect, and we don’t know how to dose it for different individuals or different outcomes. The latter concern is a big sticking point for skeptics. This recent hypothesis and the growing body of literature shows that it is possible to further understand H2, and the differences in effectiveness between hydrogen water and hydrogen inhalation. This deepening understanding fully eradicates hydrogen therapy research from the realm of quackery, inserting it into proper science. That is, if skeptics are bothering to pay attention.

Dose Dependent?
Despite not knowing what the appropriate dose is for different conditions, we do know that in no instance has a higher dose shown to be less effective, yet often a lower dose has shown to be less effective or flat out ineffective. Also, in no instance has a higher dose shown to be harmful. Knowing this, we can prudently and safely, recommend the highest dose available as research progresses. This gives the maximum chance of benefit with no known risk as we expand our knowledge and understanding.


Our knowledge on the mechanisms of action of hydrogen gas are growing each year, and as they grow, user and clinical data suggesting it is safe and effective has grown at each step. There is a long way to go in understanding how hydrogen gas works as a therapeutic agent, and much replication work needed in the human clinical research. So long as companies are marketing products that actually work to create what we believe to be a therapeutic dose (the more the better), and refrain from targeting a desperate population with promises of a magic cure, there is no rational argument to why adults presented with honest marketing shouldn’t be allowed to choose, if they wish, to spend their hard earned dollars on a promising molecule that could potentially improve their health in numerous outcomes.