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Cardiovascular Health : Hard Data for Hard Water 3-6-08
Are people who drink "hard" water containing higher levels of calcium and/or
magnesium less likely to suffer cardiovascular disease? This is the question
that delegates who attended a World Health Organization (WHO) meeting 21–22
January 2008 in Geneva, Switzerland, are now trying to answer once and for all.
The idea that hard water—particularly that with higher magnesium
concentrations—helps ward off cardiovascular problems has been around for 50
years. However, due to the ecologic nature of most studies, uncontrolled
confounding factors, and the different variables and outcomes measured, no firm
conclusions have ever been drawn. The WHO is therefore coordinating worldwide
efforts to compare cardiovascular morbidity before and after changes in the
calcium/magnesium content of water supplies.
The aim of the Geneva meeting was to discuss how such a study—ultimately a
composite of many smaller studies from different nations—should be performed. "A
prospective, multi-country study following a single protocol would be the best
way to ensure a sufficiently large sample for overall analysis . . . if we are
to make meaningful comparisons," says Paul Hunter, a professor of health
protection at the University of East Anglia, United Kingdom, whose group has
been testing a possible protocol.
Hunter's work involved obtaining mortality and residence data on individuals in
areas where notable changes in water hardness had occurred through the
introduction or cessation of softening practices, allowing trends in
cardiovascular mortality before and after the change in water hardness to be
detected.
Controlling the confounding factors in a final meta-analysis involving
populations from different countries could pose problems, but "the 'before and
after' nature of the individual studies should certainly provide meaningful
results at the population level," he says.
The mechanism by which hard water may provide protection against cardiovascular
disease remains a matter of debate. The extra calcium it carries could help
reduce blood pressure, whereas low serum magnesium concentrations—common to
people living in soft-water areas—appear linked with arrhythmias. "Couple this
with the fact that many of today's refined foods are low in magnesium, that many
people in developed countries either do not cover or only barely cover their
magnesium needs, and that magnesium in drinking water is more bioavailable than
that in food, and you can see how [even the relatively small] extra supply of
this mineral to people in hard-water areas could be beneficial," says Frantisek
Kozísek, head of the National Reference Centre for Drinking Water in Prague,
Czech Republic. "Cooking food in soft water also tends to remove magnesium,
calcium, and other essential elements from food, making matters worse."
The results could lead to countries adopting legislation to supplement drinking
water supplies in soft-water areas with calcium and magnesium. Kozísek has
already proposed that levels of calcium and magnesium in drinking water be set
at 40–80 mg/L and 20–30 mg/L, respectively. "The available evidence suggests
these ranges could be beneficial, and . . . there is no evidence that harder
water causes any harm," he explains.
Regu Regunathan, a consultant for the Water Quality Association, says that any
recommendations on magnesium or other minerals must be based on absolutely solid
data; otherwise, desalination plants and industries providing water softeners
and reverse osmosis devices could be needlessly affected. Indeed, soft water has
palpable technical advantages over hard water, including reduced scaling in
appliances, pipes, and on surfaces, as well as better soap lathering. To this,
Kozísek responds, "If health and technical aspects of water are in
contradiction, then cost–benefit analyses of the consequences of both aspects
should be made to decide what is more important for society."