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The mechanisms behind this upregulation appear to involve: Activation of the Nrf2 pathway, which controls the expression of various antioxidant enzymes including GR Modulation of cellular signaling cascades that respond to redox status Alteration of mitochondrial metabolism, influencing NADPH availability for GR activity Reduction of inflammatory signaling that can suppress antioxidant enzyme expression These effects suggest that hydrogen water may provide a "hormetic" stimulusa mild oxidative challenge that triggers beneficial adaptive responses in cellular antioxidant systems

DeL, HY, KT, MB and JR added critical intellectual content to the manuscript and can be considered experts on the topic