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Characteristics of natural mineral waters


“Natural mineral water” means ‘microbiologically wholesome’ water, but ensures the absence of the main contamination indicators (parasites and pathogenic microorganisms, Escherichia coli and fecal streptococci, sporulated sulphite-reducing anaerobes, pseudomonas aeruginosa) both at source and during its marketing (13). The characteristics of a natural mineral water have to be proved from different points of view:

geological and hydrological, that requires a detailed description of the catchment site, considering the nature of the terrain, the stratigraphy of the hydrogeological layer and a description of the catchment operations;

physical, chemical and physicochemical, that implies a report about the main physical and chemical analysis to describe the final characteristics of the mineral water (i.e. rate of flow of the spring, temperature at source, dry residues at 180°, pH, anions and cations, trace elements, toxicity of certain constituent elements);

microbiological, ensuring the absence of the main contamination indicators;

possible pharmacological, physiological and clinical effects. The clinical researches should be conducted in order to certificate the physiological effects and benefits on human health; they should be scientific studies, conducted in long term periods and with different methodologies (13, 14).

Classification of natural mineral waters based on fixed residue at 180°C (14). By law, there is no upper or lower limits for minerals contents in natural mineral water; instead of the tap drinking water, that are strictly regulated as regards the fixed residue at 180°C.

On the basis of minerals content, waters have been classified in several ways: Marotta and Sica classification (1933) represents in Italy the first reference and it takes into consideration temperature, fixed residue and chemical composition, according to a scheme that includes classes and subclasses. They gave a name to each mineral water considering, firstly, the prevalent anion and secondly, the cation; they classified waters as salt waters, salty-sulfate waters, bicarbonate-sulfate waters, salt-bromine-iodine waters, etc. (3). Although in Europe and in United States there are many categorizations of mineral waters (17, 18), nowadays the 2009/54/EC Directive is the European reference to classify them. As reported in the EC Directive, mineral waters can be:

“Water with bicarbonate”, if bicarbonate content is >600 mg/L

“Water with sulfate”, if sulfate content is >200 mg/L

“Water with chloride”, if chloride content is >200 mg/L

“Water with calcium”, if calcium content is >150 mg/L

“Water with magnesium”, if magnesium content is >50 mg/L

“Water with fluoride”, if fluoride content is >1 mg/L (More than 1,5 mg/L of fluoride is unsuitable for children below the age of 7)

“Acid water”, if the CO2 content is >250 mg/L

“Water with sodium”, if sodium content is >200 mg/L. The lettering “indicate for low sodium diet” can be added to labels if sodium content is <20 mg/L.

Sulphate mineral waters”

Sulphate mineral water is characterized by the presence of sulphate anion, with different cations (4). The presence of specific cations combined with sulphate enhance the properties of these waters: magnesium sulphate and sodium sulphate mineral waters demonstrated to be really efficient for functional constipation conditions (31). Drinking mineral water rich in magnesium sulphate and sodium sulphate can confer significant benefits for healthy digestion, in terms of improvement of constipation symptoms, overall bowel movements and stool consistency (32).

A more complex mineral system, as the sulphate-bicarbonate-calcium-magnesiac mineral water, has a therapeutic activity in the functional disorders of the biliary tract: this water is particularly efficient thanks to elective anions that exert choleresis and cholagogue actions, helping to remove the gallbladder hypomotility and to correct the tendency to biliary sludge (33).

Sulphate is an obligate nutrient for numerous metabolic and cellular processes, particularly in foetal growth and development. For this reason sulphate mineral waters demonstrate to be an alternative choice for diet of pregnant women (34)

Bicarbonate mineral waters”

Bicarbonate natural mineral waters are cold and alkaline mineral waters with low mineral content and diuretic properties. Several studies have demonstrated the positive effects of bicarbonate mineral waters on digestive tract. Studies on crenotherapy treatments (20) and on patients with functional dyspepsia show that the consumption of bicarbonate mineral water may neutralize acid secretion, increase the pH level in the gastric lumen, accelerate gastric emptying and stimulate the release of digestive hormones (known to have pivotal roles in the regulation of gastric function) (21).

The alkali load of this mineral water seems to be important for the decrease of bone resorption. Few studies investigated the properties of bicarbonate-rich mineral water, especially waters with a strongly negative potential renal acid load. They proved to create an alkaline environment and decrease bone resorption and bone resorption markers (C-telopeptides) (23). This effect is demonstrated in subjects with adequate calcium intake and in comparison with acid calcium-rich mineral waters (sulphate calcium-rich mineral waters) (24).

Many studies show the health effects of bicarbonate mineral water on cardiometabolic risk biomarkers (reducing especially total-cholesterol, fasting glucose and LDL-cholesterol) (25) and in the prevention of Cardiovascular Diseases (CVD). In particular, sodium-bicarbonate waters demonstrated to significantly decrease serum total cholesterol and LDL-cholesterol, to increase HDL-cholesterol and, moreover, produce a significant reduction in soluble intercellular adhesion molecule (26, 27). Moreover, compared to low mineral waters, sodium-bicarbonate waters decrease post-prandial lipaemia and aldosterone levels (28). The capacity of reducing lipaemia after meals may be associated to the capacity of lowering increase in cholecystokinin concentration and lowering gallbladder emptying, which may limit the release of biliary salts into the duodenum and therefore reduce postprandial lipaemia (29), especially the plasma triglyceride (VLDL triglyceride and chylomicron triglyceride) (30).

Calcic mineral waters”

Calcium is the main mineral of the calcic mineral waters. It is generally recognized that calcium intake is important for skeletal health and that it may be beneficial to several non-skeletal body systems, as nervous system, muscle and blood system (37). Calcium is a cation that can be associated with different anions, that give to calcium mineral waters specific properties. The main anions are bicarbonate and sulphate. Some studies investigated the potential role of bicarbonate calcium-rich water in maintaining an alkaline environment and in improving acid-base balance in the body (38, 39). In fact, diet components (and also mineral waters) may have basic or acid effects and their role on bone mineral density, especially in elderly, have been largely studied (40). The study conducted by Wynn et al. on European and North American commercial waters reveals that bicarbonate calcium-rich water has an alkalizing power and may increase serum and urinary pH, creating an optimal environment for bone mineralization (39). A French study shows that in post-menopausal women, with low calcium intake, the consumption of high calcium mineral water lowers indices of bone remodeling (41). A systematic review and a meta-analysis on five studies shows that, although only a few studies with a relatively small number of subjects are available, the calcium bioavailability of mineral waters is at least comparable to, and possibly better than, that from dairy products or pharmaceutical preparations (42). Because of calcium bioavailability, high-calcium mineral waters represent an important dietary source of calcium and should be recognized as good low-calorie nutritional calcium supplements (43). The beneficial effects of calcium-rich mineral water on bone mineralization is widely demonstrated. A study conducted by Costi et al. on 255 women shows that using regularly water rich in calcium improves the average spine mineral density (44). Similar results was shown in the study of Aptel that included 4434 women over 75 years of age. An increase of 100 mg/day in calcium from drinking water was associated to a 0.5% increase in femoral bone density (45).

Magnesiac mineral waters”

Magnesiac mineral waters are characterized by magnesium as the essential component. This water may be useful in obstetric-gynecologic pathologies: pre-menstrual syndrome, climaterium and postmenopausal osteoporosis (3).

Magnesium may be combined with other minerals. Magnesium sulphate mineral waters improves bowel function, in terms of reduction of constipation, improvement in the constipation symptoms and overall bowel movements (32). In vitro studies demonstrated that magnesium sulphate may act as a cathartic by increasing the aquaporin 3 (AQP3) expression level and by changing osmotic pressure in the colon (47).

Sulphate-bicarbonate-calcium-magnesiac mineral waters proved to have therapeutic activity in the functional disorders of the biliary tract. High magnesium content favors the Oddi sphincter relaxation and allows the bile flowing, improving biliary ducts activity (33).

Results from a recent meta-analysis demonstrate that in European population, (in particular in Scandinavian population), high levels of magnesium in drinking water may reduce the risk of Coronary Heart Disease (CHD) mortality (48).

Fluorurate mineral waters”

Mineral waters with fluoride may be indicated for children, because they can reduce the incidence of decay and promote bone mineralization. However, fluorurate mineral water consumption has to be maintained low (49). The concerns about high fluoride intake are related to their possible carcinogenic effect, but actually the results of epidemiological and animal models studies show that fluorurate mineral water is not directly associated to cancer risk (50, 51).

High fluorurate mineral water consumption may have some toxic effects: from dental fluorosis to skeletal fluorosis, if fluoride intake is above than 10 mg/L (49). For this reason, the European Food Safety Agency (EFSA) established fluoride upper limit of exposure to 1,5 mg/L/die (52). This value limit is confirmed also by World Health Organization (53).

Sodium-rich mineral waters”

Sodium-rich mineral waters are characterized by the presence of sodium as the main cation, that can be associated to different anions.

The concern about the consumption of this water and the association with hypertension is reasonable when sodium is bound to chloride. In this case, they are not recommended to subjects suffering for cardiovascular diseases (CVD) (4).

Article information

Clin Cases Miner Bone Metab. 2016 Sep-Dec; 13(3): 173–180.
Published online 2017 Feb 10. doi: 10.11138/ccmbm/2016.13.3.173
PMCID: PMC5318167
PMID: 28228777
Sara Quattrini, Barbara Pampaloni, and Maria Luisa Brandi
Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Address for correspondence: Maria Luisa Brandi, MD, PhD, Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy, Phone: +39 055 7946304; Fax: +39 055 7946302, E-mail: ti.ifinu@idnarb.asiulairam
Copyright ©️ 2016, CIC Edizioni Internazionali
This article has been cited by other articles in PMC.
Articles from Clinical Cases in Mineral and Bone Metabolism are provided here courtesy of CIC Edizioni Internazionali

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