Magnesium deficiency appears to have caused Eight Million sudden coronary deaths in America during the period 1940-1994, based on census data and studies of similar deaths from magnesium deficiency conducted in Canada, Great Britain, Finland, and India. This global pattern of death from magnesium deficiency is important in terms of setting priorities for further research and setting standards of nutrition. The needless drag on the U. S. economy from magnesium deficiency exceeds $86 Billion per year.
The United States Dept. of Agriculture reported that only 25% of 37,000 consumers surveyed had a dietary magnesium intake that equalled or exceeded the Recommended Daily Allowance (RDA), and 39% of those surveyed ingested less than 70% of the magnesium RDA (22). Many others have reported widespread magnesium deficiency (1,2,3,4,7,8,10,12,17,18,19,20,23,32,34).
Fatal Chronic magnesium deficiency shows few recognized symptoms until cardiac arrhythmia occurs (1,21,31). Magnesium deficiency may cause migraine and premenstrual syndrome (13,14,15,16,24,26,27,28,33).
To calculate the probable number of American deaths caused by magnesium deficiency since 1940, I have calculated the numbers of the American population that would correspond by age and sex to those in each of the foreign studies. In each study, foreign populations were divided into groups receiving magnesium-rich water or a magnesium-rich diet, and a second group receiving less magnesium. By obtaining the two annual death rates for each set of two groups, it is possible to calculate the difference in death rates and apply that rate to the corresponding American population group, limited by age and sex. This may understate the true U. S. deaths caused by magnesium deficiency, as deaths occurring outside the age or sex limits of each study are not represented.
A global pattern emerges of large numbers of sudden cardiac deaths which can be correlated to magnesium deficiency, and it seems reasonable to suppose that American rates of such deaths would fall within or near the parameters experienced by the benchmark countries of Great Britain, Finland, Canada, and India.
In Great Britain (8) sudden coronary death was recorded for the M/F population ages 25-64 in Glasgow (low Mg in water) and London (high Mg in water), and the difference in death rates was found to be .001813. The average number of Americans 25-64 in the period 1940 to 1994 is 90,131,722, which, when multiplied by the difference in annual death rates between high and low magnesium intake gives 163,409, which, when multiplied by 54 years gives 8,824,076 American deaths in that age group during the period 1940-1994 which can be projected to have occurred from magnesium deficiency. Note that sudden coronary deaths occurring before age 25 and after age 64 are not included, so the projection may be understating total American deaths from magnesium deficiency.
In Finland (25) only male deaths were studied, ages 40-59, which had a coronary heart disease annual death rate that was .004578 different between the areas of high and low magnesium intake from water. The corresponding American male population aged 40-59 averaged 20,335,107 from 1940-1994. When that population is multiplied by the difference in death rates between areas of high and low magnesium intake, it gives 93,094, which, when multiplied by 54 years gives 5,027,082 American deaths in that sex and age group during the period 1940-1994 which can be projected to have occurred from magnesium deficiency. Note that coronary death among all women and deaths by men before age 40 or after age 59 are not included, so the projection may be understating total deaths from magnesium deficiency.
In Ontario, Canada (3), sudden ischemic heart disease deaths were compared for two M/F populations aged 35-74 ingesting different levels of magnesium in water. The annual difference in sudden death rates was .000750. The equivalent age group in the U. S. numbered an average of 73,351,322 from 1940-1994, which, when multiplied by .000750 gives 55,013, which, when multiplied by 54 years gives 2,970,729 American deaths in that age group that can be projected to have occurred from magnesium deficiency. Note that sudden coronary deaths by people under 35 or over 74 are not included, so the projection may be understating total American deaths from magnesium deficiency.
In India (32) two groups composed almost totally of males aged 25-63 were given two different diets, one averaging 1142 mg magnesium per day, and the other averaging 418 mg magnesium per day. The annual difference in death rates was .006241. The equivalent male population in the U. S. averaged 44,185,470 during the period 1940-1994, which, when multiplied by the difference in death rates gives 275,762 per annum; multiplied by 54 years gives 14,891,122 American deaths in that sex and age group which can be projected to have occurred from magnesium deficiency. Note that women, and all men under 25 or over 63, were not included, so the projection may be understating total deaths from magnesium deficiency.
It can be inferred from these foreign studies that nearly eight million Americans have needlessly died from a deficiency of magnesium, which apparently could have been easily and cheaply avoided by drinking magnesium-rich water, or by a major change to the traditional Asian diet, which is generally twice as magnesium-rich as the Western diet (5).
If the benchmark average Mg-deficiency death rate of .003345 is applied to a current world population of near 6 billion, the annual global deaths from Mg deficiency are about 20,000,000. The American rate of death from Mg-deficiency is likely to be above the benchmark average because the American diet is particularly Mg-deficient; American beer contains only a fraction of the Mg contained in European beers; American bottled water contains only 10% as much magnesium as bottled water in the rest of the world; and American processed foods and snack foods are Mg-deficient because processing often removes Mg. These points and references can be found in our Citizen Petitions to the FDA, available at http://www.mgwater.com/, our home page.
In view of the average 590 American deaths caused each day by magnesium deficiency, I recommend that the FDA require all bottled water sold in the U. S. to contain at least 90 mg/L magnesium, which can be accomplished by filtering non-spring waters through Akdolit, Neutralite, or Magno (10), or by adding magnesium chloride, magnesium citrate, or magnesium carbonate.
The FDA or other governmental agencies should sponsor further research, as magnesium is too cheap and common for any business to justify spending the millions necessary to produce the 4,000 pounds of documents required by the FDA for new drug or nutrient approval. The current literature on magnesium and Sudden Death weighs perhaps less than 100 pounds, although the evidence is overwhelming.
Water-borne magnesium is more completely and readily absorbed by the gut than is food-borne magnesium (10).
Changing a population's diet to include magnesium-rich foods appears to be less practical and less likely than improving the magnesium content of drinking water, particularly bottled water, and water-based beverages. European brands of water commonly contain 27 mg/L or more magnesium, while domestic American brands average 3 mg/L magnesium.
WATER NAME COUNTRY MAGNESIUM RDI%* (mg/Liter) (8 oz) -------------------------------------- --------- ---------- ----- Adobe Springs USA 110 6 Santa Ynez USA 87 19 S. Pellegrino ITALY 57 3 Penafiel MEXICO 41 2 Vittel FRANCE 38 2 Evian FRANCE 24 1 Naya CANADA 22 1 Volvic FRANCE 7 0 Saratoga Mineral Water USA 7 0 Perrier FRANCE 5 0 Alhambra USA 5 0 Arrowhead USA 5 0 Sparkletts Drinking Water USA 5 0 Calistoga Mineral Water USA 2 0 Cobb Mountain USA 2 0 Polar Spring Water USA 2 0 aSante Mineral Water USA 1 0 Black Mountain USA 1 0 Crystal Geyser Sparkling Mineral USA 1 0 *RDI=Recommended Daily Intake, which for Mg is 400 mg/day. RDI%=% of Recommended Daily Intake per 8 oz. serving.
The source of information on mineral content of various brands was "The Pocket Guide to Bottled Water" (35), except that it did not mention Naya or the Adobe Springs .
French medical literature has recommended that bottled water contain at least 30-90 mg/L magnesium (22). Except in the presence of renal failure, there is no need to limit magnesium intake (6); at extremely high dosages, magnesium is commonly used as a laxative, but does not have that effect at a low dosage of 90 mg/L.
The poor showing of American brands is probably due to historic campaigns by the FDA and AMA against health claims for minerals in water. In 1880 America had many brands of mineral-rich water, but by 1950 Americans had been educated to believe that "pure" water was best, meaning no minerals. The European tradition is just the opposite, placing a high value on minerals in water. The Europeans were right, at least in regard to magnesium.
Some magnesium literature stresses that the calcium/magnesium ratio in water should be about 2 to 1 to benefit the heart (10,11,18,37,38), and that corrosiveness should be avoided as lead and cadmium can be leached out of pipes (11). The Langelier and Ryznar Indexes of corrosivity work only with waters containing calcium carbonate. Such indices are "more useful after the fact, in helping to understand possible causes of the problem (corrosion) rather than being useful in a predictive sense" (36).
Empirical tests need to be invented of the leaching capability for lead and cadmium of all municipal waters (11,29). Bottled spring water contacts primarily cooking utensils, so leaching may be of less concern.
What are the characteristics of the ideal bottled water? 1. Most important, it should have as much magnesium as possible without triggering the laxative effect, which seems to start at about 150 mg/L. 2. It should have as little sodium as possible. 3. It should have a high magnesium-to-calcium ratio (18). Here is how existing brands rate in those categories.
WATER NAME COUNTRY MAGNESIUM CALCIUM SODIUM (mg/L) (mg/L) (mg/L) ---------------------------------------------------------------- -- Adobe Springs USA 110 3.3 5 Santa Ynez USA 87 19 - S. Pellegrino ITALY 57 203 46 Penafiel MEXICO 41 131 159 Vittel FRANCE 38 181 3.7 Evian FRANCE 24 78 5 Naya CANADA 22 38 6 Volvic FRANCE 7 10 10.7 Saratoga Mineral Wtr USA 7 64 9 Perrier FRANCE 5 143 15.2 Alhambra USA 5 9.5 5.4 Arrowhead USA 5 20 3 Sparkletts Drinking USA 5 4.6 15.2 Calistoga Mineral Wtr USA 2 8 163 Cobb Mountain USA 2 5.6 4.6 Polar Spring Water USA 2 13.2 8.9 aSante Mineral Water USA 1 4.2 160 Black Mountain USA 1 25 8.3 Crystal Geyser Spark. USA 1 1.5 30
Many bottled waters are sold for their purity or healthfulness which, in fact, cause death due to their magnesium deficiency. Based on epidemiological evidence, these deaths would not occur if the consumers instead drank water from springs richer in magnesium, such as Vittel, Penafiel, S. Pellegrino, Santa Ynez, or Adobe Springs .
To get some idea of the number of deaths caused by each company selling deficient bottled water, I have invented the "Mg-Deficiency Death Index", or MDDI-Bottled. The formula is:
GAL/YR * Benchmark Death Rate * (90-mg/L) = Deaths per yr 182 90
The way I arrived at this is: The RDA for water is eight 8-oz. servings, (64 oz. per day) which works out to 182 gallons per annum. Dividing a particular company's total annual gallonage by 182 gives the maximum number of possible customers who drink only their brand. Multiplying by the benchmark average death rate of .003465 caused by magnesium deficiency will give a ballpark estimate of the maximum number of consumers killed by that company per annum if the magnesium content were zero. Most domestic bottled waters contain 1 to 7 mg/L, so to reflect that I subtract the mg/L Mg in the subject water from 90, and divide that figure by 90. A negative number of deaths would mean the water was richer than 90 mg/L Mg, and a positive score would be the probable number of deaths caused, if indeed 90 mg/L would have been adequate Mg. This formula will work for any bottled water except one with 90 mg/L, as that would mean dividing into zero. Since nearly all domestic brands of water are very magnesium deficient, it makes little difference if the consumer drank just one brand or several different brands.
EXAMPLE: If company A sells 100,000,000 gallons per annum of bottled water with 5 mg/L magnesium, the formula gives how many deaths per annum that company has caused by selling magnesium deficient water:
(100,000,000/182) * .003345*(90-5)/90 = 1735 Deaths per yr (4.75 deaths per day)
In a similar fashion, municipal water supplies can be rated for deaths caused by magnesium deficiency (MDDI-Municipal) by ascertaining by survey how many customers drink tap water, and multiplying that by the death rate, etc. 84.2% of U. S. liquid consumption is water based, (see below), so it is possible to simply multiply the total number of tap customers by 84.2%, and multiply that figure by the death rate, etc. Most U.S. tap waters are slightly richer in magnesium (mean 5.5 mg/L) than domestic bottled water, but in some cases this benefit may be offset by lead or cadmium contaminants in plumbing (36).
Tap consumers * .003345* (90-mgs per liter)/90 = Deaths per yr
These formulas represent the entire population, including the high risk groups of infants and the aged. If the benchmark death rate should prove to be inapplicable to all age and sex groups, the formulas could overstate or understate the deaths. To apply the formulas to only the average of benchmark subsets, multiply the results by .248.
In addition to bottled water, attention should be paid to fortifying beverages that use water as a major ingredient, such as soft drinks, beer, coffee, tea, and powdered drinks.
U.S. Liquid Consumption Trends Estimated for 1992 by %* Soft Drinks 26.3 Coffee 14.3 Beer 12.7 Milk 10.5 Tea 3.7 Bottled Water 5.4 Juices 3.6 Powdered Drinks 3.1 Wine 1.0 Distilled Spirits .7 Imputed Tap Water Consumption 18.7 *BEVERAGE INDUSTRY Annual Manual, 1993-1994.
84.2% of U. S. liquid consumption is water-based, including beer but not including wine, spirits, milk, or juice.
The economic impact of magnesium deficiency is very considerable. Conservatively, Mg-deficiency kills 215,585 Americans per annum, mostly men in their peak earning years (30); the very old were not included in the projections, nor were the very young.
If each death had an economic value (lost life-time earnings) of only $200,000, that would be $43,117,000,000 per year of economic loss caused by Mg deficiency. If there is just one other incapacitated survivor for each fatality, the total economic loss exceeds $86 Billion per annum, and that does not include billions more spent on medical care and supporting the incapacitated.
These projections from international data represent an average of subsets of only .248 of the population. If the same rate of death proves to be applicable to the entire population, including the high-risk groups of infants and the aged, there would be 4.03 times as many deaths; so the deaths from magnesium deficiency since 1940 would be nearly 32 million, and the annual U. S. deaths from magnesium deficiency would be 869,700. Annual lost earnings would exceed $347 Billion. Sudden cardiac death is known to peak between 0 and 6 months, and between 45-75 years, according to Zipes, D. P., SUDDEN CARDIAC DEATH, American Journal of Cardiology, Feb. '79.
By comparison, the deaths from the Hiroshima atom bomb were only 80,000 to 200,000, so magnesium deficiency is equivalent to the atomic bombings of several small American cities each year. For another comparison, all American war deaths in the history of the country total much less than 2,000,000, so magnesium deficiency is a much greater catastrophe than all American wars combined. Another comparison is Hitler's Holocaust, which claimed 6,000,000 lives.
COMPARISONS OF Mg-DEFICIENCY DEATHS TO OTHER CATASTROPHES CAUSE OF DEATH LOW ESTIMATE HIGH ESTIMATE Mg Deficit 1940-1994 8,000,000 32,000,000 Annual USA Mg Deficit 215,000 869,000 Hiroshima Atom Bomb 80,000 200,000 All American War Deaths - 2,000,000 Hitler's Holocaust - 6,000,000
Unless the problem is addressed, magnesium deficiency is likely to get worse over the years because modern farming methods of tilling the soil probably cause magnesium to leach from the soil. The Illinois-American Water Co. has reported that at Alton, Illinois, the Mississippi River contains 17 mg/L dissolved magnesium, not including the undissolved dirt load. If the same concentration exists at the Mississippi's mouth, the annual loss of magnesium from Mid-western soils would be 343,590,400 cubic feet, not including the undissolved dirt load. Unlike nitrogen and other nutrients, it is not current practice in agriculture to replace the soil magnesium that is harvested or leached. Soil magnesium is so easily leached that apparently much of it has run off to the oceans; commercial magnesium is generally obtained from seawater rather than mining, as it is cheaper. Geologic formations containing ancient ocean beds commonly contain the highest concentrations of magnesium.
Magnesium is a cheap commodity, one of the most common elements on the planet. The cost of implementing fortification of bottled water-based products is a minuscule fraction of the $90-341 Billion of annual losses caused by Mg deficiency, and could be implemented in less than a year. The fortification of milk with vitamin D provides a good benchmark for gauging costs. Economists should be in the forefront of advocating the end of Magnesium deficiency; it would boost the economy greatly, as well as save precious lives.
I wish to particularly thank Dr. Mark J. Eisenberg, Dr. Egelius Spierings, and Dr. Burton Altura for sharing journal reprints or other information with me. I applaud my wife, Janet, for her excellent suggestions, hard work, and computer support.
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2. Anderson, T. W., Neri, L. C., Schreiber, G. B., Talbot, F. D. F., Zdrojewski, A., Ischemic heart disease, water hardness and myocardial magnesium, CMA Journal 113:199-203, 1975.
3. Anderson, T. W., Leriche, W. H., Hewitt, D., Neri, L. C., Magnesium, water hardness, and heart disease, Magnesium in Health and Disease, pp. 565-571, 1980.
4. Anderson, T. W., Hewitt, D., Neri, L. C., Schreiber, G., Talbot, F., Water hardness and magnesium in heart muscle, Lancet, pp. 1390-1391, December 15, 1973.
5. Chu, H. I., Liu, S. H., Hsu, H. C., Choa, H. C., and Cheu, S. H., Calcium, phosphorus, nitrogen, and magnesium metabolism in normal young Chinese adults, Chinese M. J., 59: 1, 1941.
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7. Crawford, Margaret D., Gardner, M. J., Morris, J. N., Changes in water hardness and local death-rates, Lancet, pp. 327-329, August 14, 1971.
8. Crawford, T., Crawford, Margaret D., Prevalence and pathological changes of ischaemic heart-disease in a hard-water and in a soft-water area, Lancet, pp. 229-232, February 4, 1967.
9. Durlach, J., Durlach, V., Rayssiguier, Y., Ricquier, D., Goubern, M., Bertin, R., Bara, M., Guiet-Bara, A., Olive, G., Mettey, R., Magnesium and thermoregulation. I. Newborn and infant. Is Sudden Infant Death Syndrome a magnesium-dependent disease of the transition from chemical to physical thermoregulation?, Magnesium Research, 4, 3/4, 137-152, 1991.
10. Durlach, J., Bara, M., Guiet-Bara, A., Magnesium level in drinking water and cardiovascular risk factor: A hypothesis, Magnesium 4: 5-15, 1985.
11. Durlach, J., Bara, M., Guiet-Bara, A., Magnesium level in drinking water: its importance in cardiovascular risk, Magnesium in Health and Disease, pp. 173-182, 1989.
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13. Gallai, V., Sarchielli, P., Morucci, P., Abbritti, G., Red blood cell magnesium levels in migraine patients, Cephalagia, pp. 94-98, 1993.
14. Gallai, V., Sarchielli, P., Coata, G., Firenze, C., Morucci, P., Abbritti, G., Serum and salivary magnesium levels in migraine. Results in a group of juvenile patients, Headache, pp. 132-135, March, 1992.
15. Facchinetti, F., Sances, G., Borella, P., Genazzani, A. R. Nappi, G., Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium, Headache, pp. 298-301, May, 1991.
16. Facchinetti, F., Borella, P., Sances, G., Fioroni, L., Nappi, Rossella, E., Genazzani, A. R., Oral magnesium successfully relieves premenstrual mood changes, Obstetrics & Gynecology, pp. 177-181, Vol. 78, No. 2, August 1991.
17. Jones, John E., Manalo, Romualda, Flink, Edmund B., Magnesium requirements in adults, American Journal of Clinical Nutrition, Vol. 20, No. 6, pp. 632-635, June, 1967.
18. Karppanen, H., Epidemiological studies on the relationship between magnesium intake and cardiovascular diseases, Artery 9:190-9, 1981.
19. Karppanen, H., Neuvonen, P. J., Ischaemic heart-disease and soil magnesium in Finland, Lancet, p. 1390, December 15, 1973.
20. Karppanen, H., Tanskanen, A., Tuomilehto, J., Puska, P., Vuori, J., Jantti, V., Seppanen, M., Safety and effects of potassium- and magnesium-containing low sodium salt mixtures, Journal of Cardiovascular Pharmacology 6:s236-s243, 1984.
21. Kubena, K. S., Durlach, J., Historical review of the effects of marginal intake of magnesium in chronic experimental magnesium deficiency, Magnesium and Cardiovascular Disease, pp.219-226.
22. Marier, J. R., Magnesium content of the food supply in the modern-day world, Magnesium 5:1-8, 1986.
23. Marier, J. R., Nutritional and myocardial aspects of magnesium in drinking-water, Magnesium Bull 1a:48-54, 1981.
24. Mauskop, A., Altura, B. T., Cracco, R. Q., Altura, B. M., Deficiency in serum ionized magnesium but not total magnesium in patients with migraines. Possible role of ICa 2+ /IMg 2+ ratio, Headache,pp. 136-138, March 1993.
25. Punsar, S., Karvonen, M. J., Drinking Water Quality and Sudden Death: Observations from West and East Finland, Cardiology, 64:24-34, 1979.
26. Ramadan, N. M., Halvorson, H., Vande-Linde, A., Levine, Steven R., Helpern, J. A., Welch, K. M. A., Low brain magnesium in migraine, Headache, pp. 416-419, 1989.
27. Sarchielli, P., Coata, G., Firenze, C., Morucci, P., Abbritti, G., Gallai, V., Serum and salivary magnesium levels in migraine and tension-type headache. Results in a group of adult patients, Cephalagia, pp. 21-21, 1992.
28. Schoenen, J., Sianard-Gainko, J., Lenaerts, M., Blood magnesium levels in migraine, Cephalagia, pp. 97-99, 1991.
29. Schroeder, Henry, Kraemer, Luke A., Cardiovascular mortality, municipal water, and corrosion, Arch Environ Health, Vol 28, pp. 303-311, June 1974.
30. Lown, Bernard, Sudden cardiac death: the major challenge confronting contemporary cardiology,The American Journal of Cardiology, Vol 43, p. 313, Feb 1979.
31. Seelig, Mildred S., The requirement of magnesium by the normal adult, American Journal of Clinical Nutrition, Vol. 14, pp. 342-389, June 1964.
32. Singh, R. B., Effect of dietary magnesium supplementation in the prevention of coronary heart disease and sudden cardiac death, Magnesium Trace Elem 9: 143-151, 1990.
33. Swanson, Don R., Migraine and magnesium: Eleven neglected connections, Perspectives in Biology and Medicine, 31, 4 pp. 526-557, 1988.
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