David
Co-Founder
Something I have been pondering for awhile now is our water supply and its potential health effects. In more natural environments, humans would drink from water supplies that tended to have plenty of trace minerals, especially calcium and magnesium. These days we tend to filter the heck out of everything and often utilize systems such as reverse osmosis water filters or purchase distilled water or low-mineral bottled water. What this means is most, if not all of the minerals in the water is removed. As I'll showcase, there are potential negative affects in healthy populations when such water is consumed.
I theorize that people with inflammatory bowel disease, who are often deficient in these minerals already or on medications that interfere with them (such as prednisone), are negatively affected even moreso. I also wonder if this situation is why so many people do well with elemental/enteral nutrition and juicing. These are mere ponderings on my part, I don't have any data to back up my hypothesis.
In this first post I will provide information about demineralized water and its potential health effects. In the second post I will discuss adding electrolytes to your water, something anyone with IBD (regardless of what you think of the information in this thread), especially when in an active flare, should consider and discuss with their health care provider. I am only scratching the surface here and I invite all of you to research and reply here with additional studies and papers on the subject.
I realize there is a lot of information in this thread, but I strongly suggest you read it all. There is some truly stunning information for those of you who are interested in dietary improvement of your IBD. For example,
According to the World Health Organization:
- Demineralized water "attacks distribution piping and leaches metals and other materials from the pipes and associated plumbing materials." -- I wonder what it dos to our intestinal tract if it does that to pipes.
- The WHO concluded that “not only does completely demineralised water (distillate) have unsatisfactory organoleptic properities, but it also has a definite adverse influence on the animal and human organism. After evaluating the available health, organoleptic, and other information, the
team recommended that demineralised water contain 1.) a minimum level for
dissolved salts (100 mg/l), bicarbonate ion (30 mg/l), and calcium (30 mg/l),; 2.) an optimum level for total dissolved salts (250-500 mg/l for chloride-sulfate water and 250-500 mg/l for bicarbonate water); 3.) a maximum level for alkalinity (6.5 meq/l), sodium (200 mg/l), boron (0.5 mg/l), and bromine (0.01 mg/l)."
- "A study by Williams (1963) reported that distilled water introduced into the intestine caused abnormal changes in epithelial cells of rats, possibly due to osmotic shock. However, the same conclusions were not reached by Schumann et al. (1993) in a more recent study based on 14-day experiments in rats. Histology did not reveal any signs of erosion, ulceration or inflammation in the oesophagus, stomach and jejunum. Altered secretory function in animals (i.e., increased secretion and acidity of gastric juice) and altered stomach muscle tone were reported in studies for WHO (1980), however, based on currently available data, a direct negative effect of low mineral content water on the gastrointestinal mucous membrane has not been unambiguously demonstrated."
- "It has been adequately demonstrated that consuming water of low mineral
content has a negative effect on homeostasis mechanisms, compromising the mineral and water metabolism in the body. An increase in urine output (i.e., increased diuresis) is associated with an increase in excretion of major intra- and extracellular ions from the body fluids, their negative balance, and changes in body water levels and functional activity of some body water management dependent hormones."
- "Experiments in animals, primarily rats, for up to one-year periods have
repeatedly shown that the intake of distilled water or water with TDS ≤ 75 mg/l leads to: 1) increased water intake, diuresis, extracellular fluid volume, and serum concentrations of sodium (Na) and chloride (Cl) ions and their increased elimination from the body, resulting in an overall negative balance if it is not adequately compensated from food, and 2) lower volumes of red cells and some other hematocrit changes (WHO 1980). Although recent studies (Rakhmanin et al. 1989) did not find mutagenic or gonadotoxic effects of distilled water, they did add new knowledge about decreased secretion of tri-iodothyronine and aldosterone, increased secretion of cortisol, morphological changes in the kidneys including a more pronounced atrophy of glomeruli, and swollen vascular endothelium limiting the blood flow. Reduced skeletal ossification was also found in rat foetuses whose dams were given distilled water in a one-year study. Apparently the reduced mineral intake from water was not compensated by their diets."
- "Results of experiments in human volunteers evaluated by researchers for the WHO report (1980) are in agreement with those reported in animal experiments. Low-mineral water markedly: 1) increased diuresis (almost by 20%, on average), body water volume, and serum sodium concentrations, 2) decreased serum potassium concentration, and 3) increased the elimination of sodium, potassium, chloride, calcium and magnesium ions from the body. The basic mechanism of the effects of water low in TDS (e.g. < 100 mg/l) on water and mineral homeostasis was suggested as follows (WHO 1980). Low-mineral water acts on osmoreceptors of the gastrointestinal tract, causing an increased flow of sodium ions into the intestinal lumen and slight reduction in osmotic pressure in the portal venous system with subsequent enhanced release of sodium into the blood as an adaptation response. This osmotic change in the blood plasma results in the redistribution of body water; that is, there is an increase in the total extracellular fluid volume and the transfer of water from erythrocytes and interstitial fluid into the plasma and between intracellular and interstitial fluids. In response to the changed plasma volume, baroreceptors and volume receptors in the bloodstream are activated, inducing a decrease in aldosterone release and thus an increase in sodium elimination. Reactivity of the volume receptors in the vessels may result in a decrease in ADH release and an enhanced diuresis"
- "The German Society for Nutrition reached similar conclusions, warning the
public against drinking distilled water (DgfE 1993). This warning was published in response to the German edition of The Shocking Truth About Water (Bragg and Bragg 1993), whose authors recommended drinking distilled water instead of "ordinary" drinking water. The Society in its position paper explains that water in the human body always contains electrolytes (e.g. potassium and sodium) at certain concentrations controlled by the body. Water resorption by the intestinal epithelium is also enabled by sodium transport. If distilled water is ingested, the intestine has to add electrolytes to this water first, taking them from the body reserves. Since the body never eliminates fluid in form of "pure" water but always together with salts, adequate intake of electrolytes must be ensured. Ingestion of distilled water leads to the dilution of the electrolytes dissolved in the body water. Inadequate body water redistribution between compartments may compromise the function of vital organs. Symptoms at the very beginning of this condition include tiredness, weakness and headache; more severe symptoms are muscular cramps and impaired heart rate."
- "Although drinking water is not the major source of our calcium and
magnesium intake, the health significance of supplemental intake of these elements from drinking water may outweigh its nutritional contribution expressed as the proportion of the total daily intake of these elements. Even in industrialized countries, diets not deficient in terms of the quantity of calcium and magnesium, may not be able to fully compensate for the absence of calcium and, in particular, magnesium, in drinking water."
- "Recent studies also suggest that the intake of soft water, i.e. water low in calcium, may be associated with higher risk of fracture in children (Verd Vallespir et al. 1992), certain neurodegenerative diseases (Jacqmin et al. 1994), pre-term birth and low weight at birth (Yang et al. 2002) and some types of cancer (Yang et al. 1997; Yang et al. 1998). In addition to an increased risk of sudden death (Eisenberg 1992; Bernardi et al. 1995; Garzon and Eisenberg 1998), the intake of water low in magnesium seems to be associated with a higher risk of motor neuronal disease (Iwami et al. 1994), pregnancy disorders (so-called preeclampsia) (Melles &Kiss 1992), and some types of cancer (Yang et al. 1999a; Yang et al. 1999b; Yang et al. 1999c; Yang et al. 2000)."
- "The importance of water calcium was also confirmed in a one-year study of rats on a fully adequate diet in terms of nutrients and salts and given desalinated water with added dissolved solids of 400 mg/l and either 5 mg/l, 25 mg/l, or 50 mg/l of calcium (WHO 1980; Rakhmanin et al. 1976). The animals given water dosed with 5 mg/l of calcium exhibited a reduction in thyroidal and other associated functions compared to the animals given the two higher doses of calcium"
- "Although drinking water, with some rare exceptions, is not the major source of essential elements for humans, its contribution may be important for several reasons. The modern diet of many people may not be an adequate source of minerals and microelements. In the case of borderline deficiency of a given element, even the relatively low intake of the element with drinking water may play a relevant protective role. This is because the elements are usually present in water as free ions and therefore, are more readily absorbed from water compared to food where they are mostly bound to other substances."
- "Recent epidemiological studies of an ecologic design among Russian
populations supplied with water varying in TDS suggest that low-mineral
drinking water may be a risk factor for hypertension and coronary heart disease, gastric and duodenal ulcers, chronic gastritis, goitre, pregnancy complications and several complications in newborns and infants, including jaundice, anemia, fractures and growth disorders (Mudryi 1999). However, it is not clear whether the effects observed in these studies are due to the low content of calcium and magnesium or other essential elements, or due to other factors."
- "Lutai (1992) conducted a large cohort epidemiological study in the Ust-Ilim
region of Russia. The study focused on morbidity and physical development in
7658 adults, 562 children and 1582 pregnant women and their newborns in two areas supplied with water different in TDS. One of these areas was supplied with water lower in minerals (mean values: TDS 134 mg/l, calcium 18.7 mg/l, magnesium 4.9 mg/l, bicarbonates 86.4 mg/l) and the other was supplied with water higher in minerals (mean values: TDS 385 mg/l, calcium 29.5 mg/l, magnesium 8.3 mg/l, bicarbonates 243.7 mg/l). Water levels of ulphate, chloride, sodium, potassium, copper, zinc, manganese and molybdenum were also determined. The populations of the two areas did not differ from each other in eating habits, air quality, social conditions and time of residence in the respective areas. The population of the area supplied with water lower in minerals showed higher incidence rates of goiter, hypertension, ischemic heart disease, gastric and duodenal ulcers, chronic gastritis, cholecystitis and nephritis. Children living in this area exhibited slower physical development and more growth abnormalities, pregnant women suffered more frequently from edema and anemia. Newborns of this area showed higher morbidity. The lowest morbidity was associated with water having calcium levels of 30-90 mg/l, magnesium levels of 17-35 mg/l, and TDS of about 400 mg/l (for bicarbonate containing waters).The authors concluded that such water could be considered as physiologically optimum. The higher mineralized water was also relatively high in bicarbonate, and Lutai suggested that the desirable bicarbonate content of drinking water should be between 250 and 500 mg/l."
- "When used for cooking, soft water was found to cause substantial losses of all essential elements from food (vegetables, meat, cereals). Such losses may reach up to 60 % for magnesium and calcium or even more for some other microelements (e.g., copper 66 %, manganese 70 %, cobalt 86 %). In contrast, when hard water is used for cooking, the loss of these elements is much lower, and in some cases, an even higher calcium content was reported in food as a result of cooking (WHO 1978; Haring and Van Delft 1981; Oh et al. 1986; Durlach 1988). Since most nutrients are ingested with food, the use of low-mineral water for cooking and processing food may cause a marked deficiency in total intake of some essential elements that was much higher than expected with the use of such water for drinking only. The current diet of many persons usually does not provide all necessary elements in sufficient quantities, and therefore, any factor that results in the loss of essential elements and nutrients during the processing and preparation of food could be detrimental for them."
- "Calcium and, to a lesser extent, magnesium in water and food are known to have antitoxic activity. They can help prevent the absorption of some toxic elements such as lead and cadmium from the intestine into the blood, either via direct reaction leading to formation of an unabsorbable compound or via competition for binding sites (Thompson 1970; Levander 1977; Oehme 1979; Hopps and Feder 1986; Nadeenko et al. 1987; Durlach et al. 1989; Plitman et al. 1989). Although this protective effect is limited, it should not be dismissed. Populations supplied with low-mineral water may be at a higher risk in terms of adverse effects from exposure to toxic substances compared to populations supplied with water of average mineralization and hardness."
- "Based on the currently available data, various researchers have recommended that the following levels of calcium, magnesium, and water hardness should be in drinking water:
• For magnesium, a minimum of 10 mg/l (Novikov et al. 1983; Rubenowitz et al. 2000) and an optimum of about 20-30 mg/l (Durlach et al. 1989; Kozisek 1992);
• For calcium, a minimum of 20 mg/l (Novikov et al. 1983) and an optimum of about 50 (40-80) mg/l (Rakhmanin et al. 1990; Kozisek 1992);
• For total water hardness, the sum of calcium and magnesium should be 2 to 4 mmol/l (Plitman et al. 1989; Lutai 1992; Muzalevskaya et al. 1993; Golubev and Zimin 1994). At these concentrations, minimum or no adverse health effects were observed. The maximum protective or beneficial health effects of drinking water appeared to occur at the estimated desirable or optimum concentrations.
The recommended magnesium levels were based on cardiovascular system effects, while changes in calcium metabolism and ossification were used as a basis for the recommended calcium levels. The upper limit of the hardness optimal range was derived from data that showed a higher risk of gall stones, kidney stones, urinary stones, arthrosis and arthropathies in populations supplied with water of hardness higher than 5 mmol/l."
I theorize that people with inflammatory bowel disease, who are often deficient in these minerals already or on medications that interfere with them (such as prednisone), are negatively affected even moreso. I also wonder if this situation is why so many people do well with elemental/enteral nutrition and juicing. These are mere ponderings on my part, I don't have any data to back up my hypothesis.
In this first post I will provide information about demineralized water and its potential health effects. In the second post I will discuss adding electrolytes to your water, something anyone with IBD (regardless of what you think of the information in this thread), especially when in an active flare, should consider and discuss with their health care provider. I am only scratching the surface here and I invite all of you to research and reply here with additional studies and papers on the subject.
I realize there is a lot of information in this thread, but I strongly suggest you read it all. There is some truly stunning information for those of you who are interested in dietary improvement of your IBD. For example,
According to the World Health Organization:
- Demineralized water "attacks distribution piping and leaches metals and other materials from the pipes and associated plumbing materials." -- I wonder what it dos to our intestinal tract if it does that to pipes.
- The WHO concluded that “not only does completely demineralised water (distillate) have unsatisfactory organoleptic properities, but it also has a definite adverse influence on the animal and human organism. After evaluating the available health, organoleptic, and other information, the
team recommended that demineralised water contain 1.) a minimum level for
dissolved salts (100 mg/l), bicarbonate ion (30 mg/l), and calcium (30 mg/l),; 2.) an optimum level for total dissolved salts (250-500 mg/l for chloride-sulfate water and 250-500 mg/l for bicarbonate water); 3.) a maximum level for alkalinity (6.5 meq/l), sodium (200 mg/l), boron (0.5 mg/l), and bromine (0.01 mg/l)."
- "A study by Williams (1963) reported that distilled water introduced into the intestine caused abnormal changes in epithelial cells of rats, possibly due to osmotic shock. However, the same conclusions were not reached by Schumann et al. (1993) in a more recent study based on 14-day experiments in rats. Histology did not reveal any signs of erosion, ulceration or inflammation in the oesophagus, stomach and jejunum. Altered secretory function in animals (i.e., increased secretion and acidity of gastric juice) and altered stomach muscle tone were reported in studies for WHO (1980), however, based on currently available data, a direct negative effect of low mineral content water on the gastrointestinal mucous membrane has not been unambiguously demonstrated."
- "It has been adequately demonstrated that consuming water of low mineral
content has a negative effect on homeostasis mechanisms, compromising the mineral and water metabolism in the body. An increase in urine output (i.e., increased diuresis) is associated with an increase in excretion of major intra- and extracellular ions from the body fluids, their negative balance, and changes in body water levels and functional activity of some body water management dependent hormones."
- "Experiments in animals, primarily rats, for up to one-year periods have
repeatedly shown that the intake of distilled water or water with TDS ≤ 75 mg/l leads to: 1) increased water intake, diuresis, extracellular fluid volume, and serum concentrations of sodium (Na) and chloride (Cl) ions and their increased elimination from the body, resulting in an overall negative balance if it is not adequately compensated from food, and 2) lower volumes of red cells and some other hematocrit changes (WHO 1980). Although recent studies (Rakhmanin et al. 1989) did not find mutagenic or gonadotoxic effects of distilled water, they did add new knowledge about decreased secretion of tri-iodothyronine and aldosterone, increased secretion of cortisol, morphological changes in the kidneys including a more pronounced atrophy of glomeruli, and swollen vascular endothelium limiting the blood flow. Reduced skeletal ossification was also found in rat foetuses whose dams were given distilled water in a one-year study. Apparently the reduced mineral intake from water was not compensated by their diets."
- "Results of experiments in human volunteers evaluated by researchers for the WHO report (1980) are in agreement with those reported in animal experiments. Low-mineral water markedly: 1) increased diuresis (almost by 20%, on average), body water volume, and serum sodium concentrations, 2) decreased serum potassium concentration, and 3) increased the elimination of sodium, potassium, chloride, calcium and magnesium ions from the body. The basic mechanism of the effects of water low in TDS (e.g. < 100 mg/l) on water and mineral homeostasis was suggested as follows (WHO 1980). Low-mineral water acts on osmoreceptors of the gastrointestinal tract, causing an increased flow of sodium ions into the intestinal lumen and slight reduction in osmotic pressure in the portal venous system with subsequent enhanced release of sodium into the blood as an adaptation response. This osmotic change in the blood plasma results in the redistribution of body water; that is, there is an increase in the total extracellular fluid volume and the transfer of water from erythrocytes and interstitial fluid into the plasma and between intracellular and interstitial fluids. In response to the changed plasma volume, baroreceptors and volume receptors in the bloodstream are activated, inducing a decrease in aldosterone release and thus an increase in sodium elimination. Reactivity of the volume receptors in the vessels may result in a decrease in ADH release and an enhanced diuresis"
- "The German Society for Nutrition reached similar conclusions, warning the
public against drinking distilled water (DgfE 1993). This warning was published in response to the German edition of The Shocking Truth About Water (Bragg and Bragg 1993), whose authors recommended drinking distilled water instead of "ordinary" drinking water. The Society in its position paper explains that water in the human body always contains electrolytes (e.g. potassium and sodium) at certain concentrations controlled by the body. Water resorption by the intestinal epithelium is also enabled by sodium transport. If distilled water is ingested, the intestine has to add electrolytes to this water first, taking them from the body reserves. Since the body never eliminates fluid in form of "pure" water but always together with salts, adequate intake of electrolytes must be ensured. Ingestion of distilled water leads to the dilution of the electrolytes dissolved in the body water. Inadequate body water redistribution between compartments may compromise the function of vital organs. Symptoms at the very beginning of this condition include tiredness, weakness and headache; more severe symptoms are muscular cramps and impaired heart rate."
- "Although drinking water is not the major source of our calcium and
magnesium intake, the health significance of supplemental intake of these elements from drinking water may outweigh its nutritional contribution expressed as the proportion of the total daily intake of these elements. Even in industrialized countries, diets not deficient in terms of the quantity of calcium and magnesium, may not be able to fully compensate for the absence of calcium and, in particular, magnesium, in drinking water."
- "Recent studies also suggest that the intake of soft water, i.e. water low in calcium, may be associated with higher risk of fracture in children (Verd Vallespir et al. 1992), certain neurodegenerative diseases (Jacqmin et al. 1994), pre-term birth and low weight at birth (Yang et al. 2002) and some types of cancer (Yang et al. 1997; Yang et al. 1998). In addition to an increased risk of sudden death (Eisenberg 1992; Bernardi et al. 1995; Garzon and Eisenberg 1998), the intake of water low in magnesium seems to be associated with a higher risk of motor neuronal disease (Iwami et al. 1994), pregnancy disorders (so-called preeclampsia) (Melles &Kiss 1992), and some types of cancer (Yang et al. 1999a; Yang et al. 1999b; Yang et al. 1999c; Yang et al. 2000)."
- "The importance of water calcium was also confirmed in a one-year study of rats on a fully adequate diet in terms of nutrients and salts and given desalinated water with added dissolved solids of 400 mg/l and either 5 mg/l, 25 mg/l, or 50 mg/l of calcium (WHO 1980; Rakhmanin et al. 1976). The animals given water dosed with 5 mg/l of calcium exhibited a reduction in thyroidal and other associated functions compared to the animals given the two higher doses of calcium"
- "Although drinking water, with some rare exceptions, is not the major source of essential elements for humans, its contribution may be important for several reasons. The modern diet of many people may not be an adequate source of minerals and microelements. In the case of borderline deficiency of a given element, even the relatively low intake of the element with drinking water may play a relevant protective role. This is because the elements are usually present in water as free ions and therefore, are more readily absorbed from water compared to food where they are mostly bound to other substances."
- "Recent epidemiological studies of an ecologic design among Russian
populations supplied with water varying in TDS suggest that low-mineral
drinking water may be a risk factor for hypertension and coronary heart disease, gastric and duodenal ulcers, chronic gastritis, goitre, pregnancy complications and several complications in newborns and infants, including jaundice, anemia, fractures and growth disorders (Mudryi 1999). However, it is not clear whether the effects observed in these studies are due to the low content of calcium and magnesium or other essential elements, or due to other factors."
- "Lutai (1992) conducted a large cohort epidemiological study in the Ust-Ilim
region of Russia. The study focused on morbidity and physical development in
7658 adults, 562 children and 1582 pregnant women and their newborns in two areas supplied with water different in TDS. One of these areas was supplied with water lower in minerals (mean values: TDS 134 mg/l, calcium 18.7 mg/l, magnesium 4.9 mg/l, bicarbonates 86.4 mg/l) and the other was supplied with water higher in minerals (mean values: TDS 385 mg/l, calcium 29.5 mg/l, magnesium 8.3 mg/l, bicarbonates 243.7 mg/l). Water levels of ulphate, chloride, sodium, potassium, copper, zinc, manganese and molybdenum were also determined. The populations of the two areas did not differ from each other in eating habits, air quality, social conditions and time of residence in the respective areas. The population of the area supplied with water lower in minerals showed higher incidence rates of goiter, hypertension, ischemic heart disease, gastric and duodenal ulcers, chronic gastritis, cholecystitis and nephritis. Children living in this area exhibited slower physical development and more growth abnormalities, pregnant women suffered more frequently from edema and anemia. Newborns of this area showed higher morbidity. The lowest morbidity was associated with water having calcium levels of 30-90 mg/l, magnesium levels of 17-35 mg/l, and TDS of about 400 mg/l (for bicarbonate containing waters).The authors concluded that such water could be considered as physiologically optimum. The higher mineralized water was also relatively high in bicarbonate, and Lutai suggested that the desirable bicarbonate content of drinking water should be between 250 and 500 mg/l."
- "When used for cooking, soft water was found to cause substantial losses of all essential elements from food (vegetables, meat, cereals). Such losses may reach up to 60 % for magnesium and calcium or even more for some other microelements (e.g., copper 66 %, manganese 70 %, cobalt 86 %). In contrast, when hard water is used for cooking, the loss of these elements is much lower, and in some cases, an even higher calcium content was reported in food as a result of cooking (WHO 1978; Haring and Van Delft 1981; Oh et al. 1986; Durlach 1988). Since most nutrients are ingested with food, the use of low-mineral water for cooking and processing food may cause a marked deficiency in total intake of some essential elements that was much higher than expected with the use of such water for drinking only. The current diet of many persons usually does not provide all necessary elements in sufficient quantities, and therefore, any factor that results in the loss of essential elements and nutrients during the processing and preparation of food could be detrimental for them."
- "Calcium and, to a lesser extent, magnesium in water and food are known to have antitoxic activity. They can help prevent the absorption of some toxic elements such as lead and cadmium from the intestine into the blood, either via direct reaction leading to formation of an unabsorbable compound or via competition for binding sites (Thompson 1970; Levander 1977; Oehme 1979; Hopps and Feder 1986; Nadeenko et al. 1987; Durlach et al. 1989; Plitman et al. 1989). Although this protective effect is limited, it should not be dismissed. Populations supplied with low-mineral water may be at a higher risk in terms of adverse effects from exposure to toxic substances compared to populations supplied with water of average mineralization and hardness."
- "Based on the currently available data, various researchers have recommended that the following levels of calcium, magnesium, and water hardness should be in drinking water:
• For magnesium, a minimum of 10 mg/l (Novikov et al. 1983; Rubenowitz et al. 2000) and an optimum of about 20-30 mg/l (Durlach et al. 1989; Kozisek 1992);
• For calcium, a minimum of 20 mg/l (Novikov et al. 1983) and an optimum of about 50 (40-80) mg/l (Rakhmanin et al. 1990; Kozisek 1992);
• For total water hardness, the sum of calcium and magnesium should be 2 to 4 mmol/l (Plitman et al. 1989; Lutai 1992; Muzalevskaya et al. 1993; Golubev and Zimin 1994). At these concentrations, minimum or no adverse health effects were observed. The maximum protective or beneficial health effects of drinking water appeared to occur at the estimated desirable or optimum concentrations.
The recommended magnesium levels were based on cardiovascular system effects, while changes in calcium metabolism and ossification were used as a basis for the recommended calcium levels. The upper limit of the hardness optimal range was derived from data that showed a higher risk of gall stones, kidney stones, urinary stones, arthrosis and arthropathies in populations supplied with water of hardness higher than 5 mmol/l."
