Individual components that define MetSyn include atherogenic dyslipidemia (alteration of blood lipid profile favouring atherosclerosis development and being characterized by high fasting blood triglycerides and low fasting blood HDL-cholesterol), elevated fasting blood glucose and (or) insulin resistance (more insulin is need to control/regulate blood glucose levels), elevated blood pressure, abdominal obesity and, most recently recognized, a pro-inflammatory and prothrombotic state [a state favouring inflammation and thrombus (blood clot) formation] (Zimmet et al 2005; Johnson et al 2006; Grundy et al 2006; Feldeisen et al 2007; Alberti et al 2009; Simmons et al 2010; Wree et al 2011).

The increasing number of individuals with MetSyn, in the past 10-15 years, has been associated with several different factors. Although the exact aetiology of the MetSyn still remains unclear, it is known to involve complex interactions between genetic, metabolic and environmental factors. Among environmental factors, diet and physical activity are of central importance in the prevention and treatment of this condition. Some minerals, like calcium, magnesium and potassium, generally deficient in MetSyn-inducing diets, due to a low ingestion of milk, dairy products, fruit, vegetables, whole grains, beans and nuts, like almonds and walnuts, have been proposed protective against the MetSyn (Feldeisen et al 2007).

Minerals and the Metabolic Syndrome. The high intake of sodium on one hand and the low intakes of potassium, calcium and magnesium on the other hand, produce and maintain elevated blood pressure in a big proportion of the population. Conversely, decreased intake of sodium alone, and increased intakes of potassium, calcium and magnesium, each alone, decrease elevated blood pressure. A combination of all these factors, that is, decrease of sodium, and increase of potassium, calcium and magnesium intakes, which are characteristic of the so-called Dietary Approaches to Stop Hypertension (DASH) diets, has an excellent blood pressure lowering effect (Van Leer et al 1995; Whelton et al 1997; Karppanen et al 2005; Geleijnse et al 2005; van Meijl et al 2008).

Research has indicated that low intake of magnesium, low blood magnesium concentrations and/or low intracellular magnesium levels may lead to and are associated with elevated blood pressure, MetSyn, insulin resistance, and/or type 2 diabetes mellitus (Song et al 2004; He et al 2006; Volpe et al 2008; Wells 2008). Experimental and clinical studies suggest that magnesium intake may decrease blood triglyceride and increase HDL-cholesterol levels (He et al 2006). Both individuals who did not have type 2 diabetes mellitus, but with insulin resistance and hypomagnesemia (low blood magnesium level), and individuals with type 2 diabetes mellitus, with hypomagnesemia, showed improved insulin sensitivity and, for type 2 diabetic individuals, improved metabolic control (lower fasting blood glucose and lower glycated haemoglobin levels), after oral magnesium supplementation (Song et al 2004; Volpe et al 2008; Wells 2008). A strong inverse relationship between magnesium levels in serum and the presence of MetSyn has been reported, in a population of overweight or obese individuals (mean age around 66 years), in which serum magnesium levels decreased as the number of components of MetSyn increased (Evangelopoulos et al 2008).

Epidemiological studies have suggested protective effects of dairy product consumption on MetSyn development. Additionally, it has been published that calcium supplements improve the serum lipoprotein profile, particularly by decreasing serum total and LDL-cholesterol concentrations (van Meijl et al 2008). In overweight or obese women (mean age 43 years), who were very low-calcium consumers, decreases in body weight, fat mass and spontaneous dietary lipid intake have been associated with calcium plus vitamin D supplementation, for 15 weeks (Major et al 2009). Based on the Korean National Health and Nutrition Examination Survey (2001 and 2005) calcium intake is inversely associated with the risk of having MetSyn in postmenopausal women (Cho et al 2009).

Drinking water and its mineral content. Several investigations evaluated the relationship between hardness of drinking water, or its content in magnesium and calcium, and the risk for cardiovascular disease or stroke. Results support the hypothesis that a low intake of magnesium in drinking water may increase the risk of dying from, and possibly developing, cardiovascular disease or stroke (Monarca et al 2006; Rylander 2008). An additional parameter to take into account is the acidity of the water (there is considerable evidence that acid-base conditions in the body influence the mineral homeostasis and it is known that acid load influences the reabsorption of calcium and magnesium in renal tubuli). It has been suggested that the health effects related to drinking water found in some studies may have been caused by an increased urinary excretion of minerals induced by acid conditions in the body and that drinking water should contain sufficient amounts of hydrogen carbonate to prevent this effect (Rylander et al 2006; Rylander 2008).

Natural mineral waters represent a substantial alkaline load and may influence mineral homeostasis in our body (Rylander 2008). Several papers in the literature point to calcium- and (or) magnesium-rich natural mineral waters as good sources of these ions (in which they are highly bioavailable), contributing to achieve their daily recommended intakes (Bohmer et al 2000; Sabatier et al 2002; Bacciottini et al 2004; Kiss et al 2004; Heaney 2006; Karagülle et al 2006).

It is interesting to mention that, besides the influence on MetSyn components (see below), the mineral content of natural waters may have other preventive/beneficial effects. It has been reported that in a Hungarian city the occurrence of preeclampsia varied pari passu with the magnesium content of the drinking water in different parts of the city (Melles et al 1992). In a different study, the consumption of 1L/day of a high calcium natural mineral water (supplement of 596 mg of calcium), for 6 months, reduced serum parathyroid hormone and indices of bone turnover in postmenopausal women with a low calcium intake (Meunier et al 2005).

Natural mineral waters and the Metabolic Syndrome components. Within the scope of beneficial effects in cardiovascular disease and MetSyn prevention, there are several publications showing that the ingestion of mineral waters with sodium bicarbonate is beneficial in lowering cardiovascular risk factors, including blood pressure (Luft et al 1990; Schorr et al 1996; Capurso et al 1999; Rylander et al 2004; Schoppen et al 2004; Almeida et al 2010a,b; Pérez-Granados et al 2010).

The consumption of 3L/day of a NaHCO3-containing mineral water, for 7 days, decreased systolic blood pressure, in mildly hypertensive men (Luft et al 1990) and the consumption of 1.5L/day of a sodium bicarbonate-rich mineral water, for 4 weeks, decreased mean arterial blood pressure, in elderly normotensive subjects (aged 60-72 years) (Schorr et al 1996). The daily ingestion of 0.5 mL of a portuguese natural mineral water rich in bicarbonate and sodium, Água das Pedras® (and with a higher content in magnesium, calcium and potassium than tap water from Porto city area, where the study took place), for 7 weeks, had no effect on blood pressure, in normotensive adults (aged 24-53 years) (Santos et al 2010). Also, administration of this natural mineral-rich water in an animal model of MetSyn did not increase blood pressure and improved some metabolic parameters (like plasma insulin and triglycerides levels) (Almeida 2010a,b).

Ingestion of a natural mineral water rich in calcium, bicarbonate and magnesium, as well as in sulphate, reduced blood pressure (systolic and diastolic) after 2 weeks (this reduction was kept until the 4 weeks of treatment) in individuals (aged 45 - 64 years) with borderline hypertension and with low urinary excretion of magnesium and calcium (Rylander et al 2004). In moderately hypercholesterolemic young adults (aged 18 - 40 years), ingestion of a bicarbonated natural mineral water (also rich in sodium, chloride and potassium; 1L/day), for 8 weeks, reduced systolic blood pressure (this alteration was observed after 4-weeks consumption, without significant differences between weeks 4 and 8), fasting serum levels of apolipoprotein B, total cholesterol and LDL-cholesterol as well as the ratios [(total cholesterol)/(HDL-cholesterol)] and [(LDL-cholesterol)/(HDL-cholesterol)] (Pérez-Granados et al 2010). In postmenopausal women, ingestion of the previous natural mineral-rich water (1L/day), for 2 months, increased fasting serum levels of HDL-cholesterol and reduced fasting serum levels of two markers of endothelial dysfunction, glucose, total cholesterol and LDL-cholesterol as well as the ratios [(total cholesterol)/(HDL-cholesterol)] and [(LDL-cholesterol)/(HDL-cholesterol)] (Schoppen et al 2004). Conclusion. Presently, with the increase in MetSyn and type 2 diabetes mellitus, associated with a high consumption of calorie-rich and micronutrient-poor foods, ingestion of natural mineral-rich waters may be beneficial. This effect will be even greater if ingestion of sweetened beverages is replaced by natural mineral-rich waters (Schulze et al 2004; Vartanian et al 2007; Feldeisen et al 2007).

References.
. Alberti KG et al. Circulation. 2009; 120(16): 1640-5.
. Almeida C et al. Chronic ingestion of a hypersaline sodium-rich carbonated natural mineral water on an animal model of the metabolic syndrome - effects on blood pressure and plasma metabolic profile. Press Therm Climat. 2010a; 147: 110-1.
. Almeida C et al. Effects of mineral supplementation on a wide spectrum of Metabolic Syndrome features. Study performed on a fructose-fed animal model. Public Health Nutr. 2010b; 13: 234.
. Bacciottini L et al. Calcium bioavailability from a calcium-rich mineral water, with some observations on method. J Clin Gastroenterol. 2004; 38(9): 761-6.
. Bohmer H et al. Calcium supplementation with calcium-rich mineral waters: a systematic review and meta-analysis of its bioavailability. Osteoporos Int. 2000; 11(11): 938-43.
. Capurso A et al. Increased bile acid excretion and reduction of serum cholesterol after crenotherapy with salt-rich mineral water. Aging (Milano). 1999 Aug;11(4):273-6.
. Cho GJ et al. Calcium intake is inversely associated with metabolic syndrome in postmenopausal women: Korea National Health and Nutrition Survey, 2001 and 2005. Menopause. 2009; 16(5): 992-7.
. Evangelopoulos AA et al. An inverse relationship between cumulating components of the metabolic syndrome and serum magnesium levels. Nutr Res. 2008; 28(10): 659-63.
. Feldeisen SE et al. Nutritional strategies in the prevention and treatment of metabolic syndrome. Appl Physiol Nutr Metab. 2007; 32(1): 46-60.
. Geleijnse JM et al. Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. J Hum Hypertens. 2005 Dec;19 Suppl 3:S1-4.
. Grundy SM et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Curr Opin Cardiol. 2006 Jan;21(1):1-6.
. Heaney RP. Absorbability and utility of calcium in mineral waters. Am J Clin Nutr. 2006; 84(2): 371-4.
. Johnson LW et al. The metabolic syndrome: concepts and controversy. Mayo Clin Proc. 2006; 81(12): 1615-20.
. Karagülle O et al. Magnesium absorption from mineral waters of different magnesium content in healthy subjects. Forsch Komplementmed. 2006; 13(1): 9-14.
. Karppanen H et al. Why and how to implement sodium, potassium, calcium, and magnesium changes in food items and diets? J Hum Hypertens. 2005; 19 Suppl 3: S10-9.
. Kiss SA et al. Absorption and effect of the magnesium content of a mineral water in the human body. J Am Coll Nutr. 2004; 23(6): 758S-62S.
. Luft FC et al. Sodium bicarbonate and sodium chloride: effects on blood pressure and electrolyte homeostasis in normal and hypertensive man. J Hypertens. 1990; 8(7): 663-70.
. Major GC et al. Calcium plus vitamin D supplementation and fat mass loss in female very low-calcium consumers: potential link with a calcium-specific appetite control. Br J Nutr. 2009; 101(5): 659-63.
. Melles Z et al. Influence of the magnesium content of drinking water and of magnesium therapy on the occurrence of preeclampsia. Magnes Res. 1992 Dec;5(4):277-9.
. Meunier et al. Consumption of a high calcium mineral water lowers biochemical indices of bone remodeling in postmenopausal women with low calcium intake. Osteoporos Int. 2005 Oct;16(10):1203-9.
. Monarca S et al. Review of epidemiological studies on drinking water hardness and cardiovascular diseases. Eur J Cardiovasc Prev Rehabil. 2006; 13(4): 495-506.
. Pérez-Granados AM et al. Reduction in cardiovascular risk by sodium-bicarbonated mineral water in moderately hypercholesterolemic young adults. J Nutr Biochem. 2010; 21(10): 948-53.
. Rylander R et al. Acid-base status affects renal magnesium losses in healthy, elderly persons. J Nutr. 2006;136(9):2374-7.
. Rylander R et al. Mineral water intake reduces blood pressure among subjects with low urinary magnesium and calcium levels. BMC Public Health. 2004; 4: 56.
. Rylander R. Drinking water constituents and disease. J Nutr. 2008; 138(2): 423S-425S.
. Sabatier M et al. Meal effect on magnesium bioavailability from mineral water in healthy women. Am J Clin Nutr. 2002; 75(1): 65-71.
. Santos A et al. Sodium-rich carbonated natural mineral water ingestion and blood pressure. Rev Port Cardiol. 2010; 29(2): 159-72.
. Schoppen S et al. A sodium-rich carbonated mineral water reduces cardiovascular risk in postmenopausal women. J Nutr. 2004; 134(5): 1058-63.
. Schorr U et al. Effect of sodium chloride- and sodium bicarbonate-rich mineral water on blood pressure and metabolic parameters in elderly normotensive individuals: a randomized double-blind crossover trial. J Hypertens. 1996; 14(1): 131-5.
. Schulze MB et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004; 292(8): 927-34.
. Simmons RK et al. The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia. 2010; 53(4): 600-5.
. Song Y et al. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women. Diabetes Care. 2004; 27(1): 59-65.
. Van Leer EM et al. Dietary calcium, potassium, magnesium and blood pressure in the Netherlands. Int J Epidemiol. 1995; 24(6): 1117-23.
. van Meijl LE et al. Dairy product consumption and the metabolic syndrome. Nutr Res Rev. 2008; 21(2): 148-57.
. Vartanian LR et al. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007; 97(4): 667-75. 
. Volpe SL. Magnesium, the metabolic syndrome, insulin resistance, and type 2 diabetes mellitus. Crit Rev Food Sci Nutr. 2008; 48(3): 293-300.
. Wells IC. Evidence that the etiology of the syndrome containing type 2 diabetes mellitus results from abnormal magnesium metabolism. Can J Physiol Pharmacol. 2008; 86(1-2): 16-24.
. Whelton PK et al. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA. 1997; 277(20): 1624-32.
. Wree A et al. Obesity affects the liver - the link between adipocytes and hepatocytes. Digestion. 2011; 83(1-2): 124-33.
. Zimmet P et al. The metabolic syndrome: a global public health problem and a new definition. J Atheroscler Thromb. 2005; 12(6): 295-300.
  • In The News
  • History of Bottled Water
Over the past two decades, bottled water has become the fastest-growing drinks market in the world. The global market was valued at $157bn in 2013 and is expected to reach $280bn by 2020.
Water is turning into wine. The same culture that surrounds the production and consumption of wine is emerging around water. Water competitions akin to wine competitions are now held.
NY Times Science
Earth is old. The sun is old. But do you know what may be even older than both? Water.
Salt Science
Washington Post declares that unknown to many shoppers urged to buy foods that are “low sodium” and “low salt,” this longstanding warning has come under assault by scientists who say that typical American salt consumption is without risk.

image
History Bottled Water
Ours is the blue planet, and the hallmark of life on Earth is water. But where did this colorless, odorless liquid first come from? Recent discoveries in astrophysics suggest that water is not native to Earth.
image
History Bottled Water
This website appeared first in 2004 and the concept of considering water at the same level as wine and food as a natural product was still new and foreign to many.