The Science Behind Tonic Water and Its Quinine Content

Can incorporating tonic water benefit individuals who want to drink more water?

Tonic Water

Tonic water is more than just water. Its bitter taste comes from quinine, a natural substance found in the bark of the Peruvian cinchona tree. Most store-bought tonic water contains quinine, with natural or artificial flavors from fruits or herbs to temper the bitterness, varying from brand to brand.

Nutrition

The following nutrition information for one 12-ounce serving of tonic water. (U.S. Department of Agriculture 2018)

• Calories – 114
• Fat – 0 grams
• Protein – 0 grams
• Sugars – 30 grams
• Sodium – 40 milligrams
• Carbohydrates – 30 grams
• Fiber – 0 grams

Calories

Tonic water calories can be high. Some brands can have up to 114 calories per bottle. The reason is they use a sweetener. Some brands have a diet version with zero calories and no sugar but may contain more sodium.

Fats and Protein

There is no fat or protein in tonic water.

Sugar

Some brands use high fructose syrup, while others use cane sugar or sugar from the other ingredients. For example, adding an alcoholic ingredient to make a tonic cocktail can significantly increase the calorie count.

Sodium

Depending on the variety and the amount drunk, tonic water can be a source of sodium. However, sodium intake should be 1500 milligrams per day.

Carbohydrates

There are 33 grams of carbohydrates per serving with the estimated glycemic load or the numerical value that estimates how much a food will raise an individual’s blood sugar to around four.

Micronutrients

There are no significant vitamins or minerals but a small amount of sodium, zinc, and copper.

Health

Quinine is FDA-approved in specific doses to treat malaria. However, the quinine in tonic water is less than prescribed for medicinal purposes. (Achan, J. et al., 2011) Some individuals have tried to use quinine for leg cramps. However, the FDA has warned that this is not recommended and can cause harm. (U.S. Food and Drug Administration. 2017)

Other Water Beverages

There are other water alternatives to reduce calories, sodium, and added sugar.

Seltzer

• Seltzer is carbonated water, similar to club soda, with no calories or added sweeteners.
• Add lemon or other fruit for flavor.

Mineral water

• Mineral water tastes like seltzer, but the carbonation is usually natural.

Flavored water

• Flavored water provides some nutrients and antioxidants from the vegetables and fruits.
• It is a great alternative if the other options don’t work.

Allergies

It is possible to have an allergy to quinine that could cause a reaction when drinking tonic water. (Winter F. D., Jr. 2015) In these cases, the research suggests, the allergy may cause:

• Thrombocytopenia – blood disorder
• Neutropenia – hematological disorder
• Anemia
• Clotting disorders
• Acute renal failure
• Liver toxicity
• Neurological abnormalities. (Howard, M. A. et al., 2003)

Make Your Own

Individuals can make tonic water with online recipes using different herbs and flavors. Tonic water made at home may or may not be lower in calories than store-bought brands, but the ingredients can be controlled to create beverages that cater to personal tastes. Using tonic or sparkling water, keep the bottled water tightly capped and chilled to maintain carbonation and ready to serve.

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Learning About Food Substitutions

References

U.S. Department of Agriculture. FoodData Central. (2018). Beverages, carbonated, tonic water. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/171869/nutrients

Achan, J., Talisuna, A. O., Erhart, A., Yeka, A., Tibenderana, J. K., Baliraine, F. N., Rosenthal, P. J., & D’Alessandro, U. (2011). Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria. Malaria journal, 10, 144. https://doi.org/10.1186/1475-2875-10-144

U.S. Food and Drug Administration. (2017). FDA drug safety communication: New risk management plan and patient medication guide for Qualaquin (quinine sulfate). Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-new-risk-management-plan-and-patient-medication-guide-qualaquin

Howard, M. A., Hibbard, A. B., Terrell, D. R., Medina, P. J., Vesely, S. K., & George, J. N. (2003). Quinine allergy causing acute severe systemic illness: report of 4 patients manifesting multiple hematologic, renal, and hepatic abnormalities. Proceedings (Baylor University. Medical Center), 16(1), 21–26. https://doi.org/10.1080/08998280.2003.11927884

Winter F. D., Jr (2015). Immune thrombocytopenia associated with consumption of tonic water. Proceedings (Baylor University. Medical Center), 28(2), 213–216. https://doi.org/10.1080/08998280.2015.11929233