Abstract
OBJECTIVES: Because of growing concern that constituents of drinking water may have adverse health effects, consumption of tap water in North America has decreased and consumption of bottled water has increased. Our objectives were to 1) determine whether North American tap water contains clinically important levels of calcium (Ca2+), magnesium (Mg2+), and sodium (Na+) and 2) determine whether differences in mineral content of tap water and commercially available bottled waters are clinically important.
DESIGN: We obtained mineral analysis reports from municipal water authorities of 21 major North American cities. Mineral content of tap water was compared with published data regarding commercially available bottled waters and with dietary reference intakes (DRIs).
MEASUREMENTS AND MAIN RESULTS: Mineral levels varied among tap water sources in North America and among bottled waters. European bottled waters generally contained higher mineral levels than North American tap water sources and North American bottled waters. For half of the tap water sources we examined, adults may fulfill between 8% and 16% of their Ca2+ DRI and between 6% and 31% of their Mg2+ DRI by drinking 2 liters per day. One liter of most moderate mineralization European bottled waters contained between 20% and 58% of the Ca2+ DRI and between 16% and 41% of the Mg2+ DRI in adults. High mineralization bottled waters often contained up to half of the maximum recommended daily intake of Na+.
CONCLUSION: Drinking water sources available to North Americans may contain high levels of Ca2+, Mg2+, and Na+ and may provide clinically important portions of the recommended dietary intake of these minerals. Physicians should encourage patients to check the mineral content of their drinking water, whether tap or bottled, and choose water most appropriate for their needs.
Similar content being viewed by others
References
Aschengrau A, Zierler S, Cohen A. Quality of community drinking water and the occurrence of spontaneous abortion. Arch Environ Health. 1989; 44:283–90.
Shy CM, Stroba RJ. Air and water pollution. In: Schottenfeld D, Fraumeni JF, eds. Cancer epidemiology and prevention. Philadelphia, Pa: W.B. Saunders; 1982:336–63.
Morton MS, Elwood PC, Abernathy M. Trace elements in water and congenital malformations of the central nervous system in South Wales. Br J Prev Soc Med. 1976; 30:36–9.
Lowe CR, Roberts CL, Lloyd S. Malformations of the central nervous system and softness of local water supplies. Br Med J. 1971; 2:357–61.
St. Leger AS, Elwood PC. Neural tube malformations and trace elements in water. J Epidemiol Community Health. 1980; 34:186–7.
Arbuckle TE, Sherman GJ, Corey PN, Walters D, Lo B. Water nitrates and CNS birth defects: a population-based case-control study. Arch Environ Health. 1988; 43:162–7.
Morris JN, Crawford MD, Heady JA. Hardness of local water supplies and mortality from cardiovascular disease. Lancet. 1961; 1:860–2.
Crawford MD, Gardner MJ. Mortality and hardness of local water supplies. Lancet. 1968; 1:860–2.
Schroeder HA. Municipal drinking water and cardiovascular death rates. JAMA. 1966; 95:125–9.
Anderson TW, LeRiche WH. Sudden death from ischemic heart disease in Ontario and its correlation with water hardness and other factors. Can Med Assoc J. 1971; 105:155–60.
Schroeder HA, Kraemer LA. Cardiovascular mortality, municipal water, and corrosion. Arch Environ Health. 1974; 28:303–11.
Eisenberg MJ. Magnesium deficiency and sudden death. Am Heart J. 1992; 124:544–9.
Eisenberg MJ. Magnesium deficiency and cardiac arrhythmias. NY State J Med. 1986; 86:133–6.
Gibson RS, Vanderkooy PS, McLennan CE, Mercer NM. Contribution of tap water to mineral intakes of Canadian preschool children. Arch Environ Health. 1987; 42:165–9.
Heany RP, Dowell MS. Absorbality of the calcium in a high-calcium mineral water. Osteoporos Int. 1994; 4:323–4.
Neri LC, Johansen HL, Hewitt D, Marier J, Langer N. Magnesium and certain other elements and cardiovascular disease. Sci Total Environ. 1985; 42:49–75.
Heany RP. Nutritional factors in osteoporosis. Annu Rev Nutr. 1993; 13:287–316.
Consensus Development Conference. Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993; 94:646–50.
Garzon P, Eisenberg MJ. Variation in the mineral content of commercially available bottled waters: implications for health and disease. Am J Med. 1998; 105:125–30.
Heany RP, Gallagher JC, Johnston CC, et al. Calcium nutrition and bone health in the elderly. Am J Clin Nutr. 1982; 36:986–1013.
The Surgeon General’s Report on Nutrition and Health. Summary and recommendations. Washington, DC: DHHS (PHS), Publication No. 88-50211; 1988.
McDowell LR. Minerals in Animal and Human Nutrition. San Diego, Ca: Academic Press; 1992:26–73, 78–95, 98–137.
Whitney EN, Corinne BC, Sharon RR. Understanding normal and clinical nutrition. 3rd ed. St. Paul, Minn: West Publishing Company; 1991:271–313, 853–92.
Marx A, Neutra RR. Magnesium in drinking water and ischemic heart disease. Epidemiol Rev. 1999; 19:258–72.
Rubenowitz E, Axelsson G, Rylander R. Magnesium in drinking water and death from acute myocardial infarction. Am J Epidemiol. 1996; 143:456–62.
Löwik MR, Grrot EH, Binnerts WT. Magnesium and public health: the impact of drinking water. In: Trace substances in environmental health, XVI: Proceedings of the University of Missouri’s 16th Annual Conference on Trace Substances in Environmental health. Columbia, Mo: University of Missouri-Columbia; 1982:189–95.
Alfonso JF, De Alvarez RR. Effects of mercury on human gestation. Am J Obstet Gynecol. 1984; 75:18–24.
Durlach J. Recommended dietary amounts of magnesium: Mg RDA. Magnesium Res. 1989; 2:195–203.
Allen HAJ. An investigation of water hardness, calcium, and magnesium in relation to mortality in Ontario. PhD Thesis. University of Waterloo, Ontario, Canada; 1972.
Karppanen H. Epidemiological studies on the relationship between magnesium intake and cardiovascular disease. Artery. 1981; 9:190–9.
Prior LAM, Evans JG, Harvey HPB, et al. Sodium intake and blood pressure in two Polynesian populations. N Engl J Med. 1968; 279:515–20.
MacGregor GA. Sodium is more important than calcium in essential hypertension. Hypertension. 1985; 7:628–37.
Kinney JM, Jeejeebhoy DJ, Hill GL, Owen OE. Nutrition and metabolism in patient care. 1st ed. Philadelphia, Pa: WB Saunders; 1988:61–88, 445–464, 701–726.
Beverage Marketing Corporation. Bottled Water in the U.S. 1995 ed.
Prince GW. Smoke on the water. Beverage World. 1996; (March):50–4.
Population Estimates Program, Population Division, U.S. Bureau of the Census, Washington, DC.
Draft Ground Water Disinfection Rule, Office of Drinking Water, U.S. Environmental Protection Agency, Washington, DC, 1992.
von Wiesenberger A. The Pocket Guide to Bottled Water. 1st ed. Chicago, Ill: Contemporary Books; 1991.
Green T, Green M. The Good Water Guide. London, England: Rosendale Press; 1994.
Hammer MJ. Water and Wastewater Technology. 3rd ed. Englewood Cliffs, NJ: Prentice Hall; 1996:21.
Committee on Dietary Reference Intakes. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997.
De Planter A. Bowes & Church’s food values of portions commonly used. Pennington JAT, ed. Philadelphi, Pa: Lippincott; 1994.
Recommended Dietary Allowances. 10th ed. Washington, DC: National Academy Press; 1989:253.
Cavallo G. Water, water everywhere...but how much is safe to drink? Cardiac Alert. 1987; 9:4–6.
Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. Baltimore, Md: Williams & Wilkins; 1999.
Author information
Authors and Affiliations
Corresponding author
Additional information
Dr. Eisenberg is a research scholar of the Heart and Stroke Foundation of Canada.
Rights and permissions
About this article
Cite this article
Azoulay, A., Garzon, P. & Eisenberg, M.J. Comparison of the mineral content of tap water and bottled waters. J GEN INTERN MED 16, 168–175 (2001). https://doi.org/10.1111/j.1525-1497.2001.04189.x
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2001.04189.x