Health Aspects of Calcium and Magnesium in Water

Beginning about 50 years ago, numerous epidemiology studies in many countries concluded that populations consuming 'hard water' containing calcium and/or magnesium have a lower risk of certain types of cardiovascular disease. These studies have not always observed the 'hard water' benefit effect, but in 2004 a committee report to WHO concluded that, on balance, the benefits hypothesis was probably valid, especially for magnesium in drinking water.  A more detailed scientific assessment of the benefits hypothesis is necessary before WHO can make a decision with respect to guidance on magnesium and calcium in drinking water.

Paul Mason, President of the Healthy Water Association, filed the following report for FineWaters:

Symposium on Health Aspects of Calcium and Magnesium in Drinking Water

Here is a summary of the most important points, as I perceived them:

• There is consensus that most of the world's people are deficient in magnesium and calcium, resulting in vast numbers of deaths and debilitating illnesses worldwide.
• There seemed to be agreement that there are only two ways of delivering adequate dietary Ca and Mg to the global population, without requiring consumers to change their behaviors or habits:

Adding calcium and magnesium to tap water.  But that is very expensive, as 99% of tap water is not used for drinking.  And, the best mineral profile for the plumbing is probably not the best mineral profile for health.  Fortifying tap water might take many years to implement.     Fortifying tap water is apparently NOT the way to deliver adequate Ca and Mg to consumers.  A small token effort may be made, adding a tiny 10 mg/L magnesium or calcium to tap water, but that will only make a small dent in the global dietary deficiency of Ca and Mg. 

Requiring bottlers to add the optimal calcium and magnesium to bottled products (probably 100 mg/L magnesium, and 200 mg/L calcium).   This is quick, easy, paid for by bottlers, and requires no changes in consumer behavior or habits.  Coca Cola's speaker said that adding magnesium doesn't change flavor, but adding calcium is harder to do without affecting flavor.  Peter Featherston of Integrated Pharmaceuticals claims to have invented a calcium additive that won't impact flavor when delivering 200 mg/L calcium in beverages.  Bottled beverages are clearly the MOST PRACTICAL way of delivering adequate Ca and Mg to global consumers.   This will most likely will be the final recommendation in 2008, as all other alternatives are probably impractical. 

• Dr. Ragnar Rylander made the important point that bicarbonate in water may improve the RETENTION of magnesium and calcium, and is therefore important.  Adobe Springs has a hefty 529 mg/L of bicarbonate, and 110 mg/L of healthful magnesium.  See:  http://www.mgwater.com/adobe.shtml
  

The US National Academy of Science, Institute of Medicine, 1997, "Dietary Reference Intakes -- Magnesium" established a Recommended Daily Intake of magnesium for adult males (US) of 420 mg per day; it also established that the average intake for adult males is only 327 mg per day, leaving a shortfall of 97 mg per day.  Rising globalization of agriculture and food supplies means that dietary intakes world-wide are converging rapidly. 

The Healthy Water Association and the Arab Healthy Water Association presented a poster at the WHO Symposium, making these points:

• Bottled beverages are the primary source of hydration in much of the world.  That trend is accelerating due to commonly polluted or foul-tasting tap supplies, rising  incomes, and incessant advertising by bottlers.
• No food is as universally consumed as are bottled beverages, so bottled beverages can deliver a more uniform dose of Mg than can fortified foods or tap water ---- which may not be consumed.
• Mg-fortifying municipal tap water would waste about 99% of the Mg-additive, as most tap water is used for flushing, washing, irrigating, etc.  Usually less than 1% of tap water is used for drinking.
• Hardened tap water may impair the sudsing and efficacy of soap.
• Many natural beverages contain more than 100 mg/l magnesium, according to USDA Nutrient Database for Standard Reference: milk 136 mg/L, orange juice 108 mg/l, grape juice 100 mg/l, and red table wines 125 mg/L.  Many non-US beers contain over 100 mg/L magnesium, as do some mineral waters. 
• Fortifying municipal tap water may be a significant financial burden on tap water suppliers. 
• Fortifying bottled beverages would cost government agencies nothing, as the minor cost would be borne by bottlers, not government agencies.
• The fortification of bottled milk with Vitamin D ended the Rickets' Disease 70 years ago, and provides a model for Mg fortification of bottled beverages. 
• If all bottled beverages contained 100 mg/l magnesium, that would bring most of the world population's intake up to the Recommended Daily Intake of Mg. 
• Fortifying tap water with 20-40 mg/l magnesium would be a reasonable compromise between the needs for washing, nutrition, and affordability.
• We are seeking to learn which Mg additives are tasteless in beverages, affordable, easily dissolved,  bio-available, and easily used, with long shelf life. 
• Magnesium Bi-carbonate (found naturally in some mineral waters) is essentially tasteless and very bio-available, with permanent shelf life, but requires CO2 for local manufacture, as it precipitates if condensed to a concentration of about 1000 mg/L. 
• Magnesium chloride has a slight impact on flavor, but was not unpleasant.

The two biggest companies distributing numerous brands of bottled water are probably Coca Cola and the Nestle company, which owns the Perrier Group of bottled water brands.  The only other representative from the bottled water industry at this WHO Symposium was me ---- I own the Adobe Springs, which supplied bottlers with natural spring water containing 110 mg/L magnesium and 529 mg/L of healthful bicarbonate.

• When both calcium and magnesium are deficient, heart attack, stroke, and osteoporosis may occur.
• When magnesium is adequate, but calcium is lacking, damage is not as extensive.
• When calcium is adequate, but magnesium is lacking, then the calcium may cause calcification of soft tissues like the heart and brain, causing strokes and heart attacks, and unwanted deposits on bones.  
• So the balance between calcium and magnesium is important.   Most researchers think the total dietary ratio of Ca/Mg should be between 2-to-1 and 1-to-1.  
• The WHO may recommend in 2008 that beverages be fortified with 100 mg/L magnesium, and 100-200 mg/L calcium.

Paul Mason, Pres.
Healthy Water Association
paulmason@MgWater.com

Resources:
Symposium on Health Aspects of Calcium and Magnesium in Drinking Water
Healthy Water Association