Objective: To evaluate the effect of a mineral water rich in magnesium (337 mg/l), calcium (232 mg/l) and bicarbonate (3388 mg/l) on urine composition and the risk of calcium oxalate crystallization.
Design: A total of 12 healthy male volunteers participated in the study. During the baseline phase, subjects collected two 24-h urine samples while on their usual diet. Throughout the control and test phases, lasting 5 days each, the subjects received a standardized diet calculated according to the recommendations. During the control phase, subjects consumed 1.4 l/day of a neutral fruit tea, which was replaced by an equal volume of a mineral water during the test phase. On the follow-up phase, subjects continued to drink 1.4 l/day of the mineral water on their usual diet and collected 24-h urine samples weekly.
Results: During the intake of mineral water, urinary pH, magnesium and citrate excretion increased significantly on both standardized and normal dietary conditions. The mineral water led to a significant increase in urinary calcium excretion only on the standardized diet, and to a significantly higher urinary volume and decreased supersaturation with calcium oxalate only on the usual diet.
Conclusions: The magnesium and bicarbonate content of the mineral water resulted in favorable changes in urinary pH, magnesium and citrate excretion, inhibitors of calcium oxalate stone formation, counterbalancing increased calcium excretion. Since urinary oxalate excretion did not diminish, further studies are necessary to evaluate whether the ingestion of calcium-rich mineral water with, rather than between, meals may complex oxalate in the gut thus limiting intestinal absorption and urinary excretion of calcium and oxalate.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
Ackermann D, Baumann JM, Futterlieb A & Zingg EJ (1988): Influence of calcium content in mineral water on chemistry and crystallization conditions in urine of calcium stone formers. Eur. Urol. 14, 305–308.
Bellizzi V, De Nicola L, Minutolo R, Russo D, Cianciaruso B, Andreucci M, Conte G & Andreucci VE (1999): Effects of water hardness on urinary risk factors for kidney stones in patients with idiopathic nephrolithiasis. Nephron 81 (Suppl 1), 66–70.
Borghi L, Meschi T, Amato F, Briganti A, Novarini A & Giannini A (1996): Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J. Urol. 155, 839–843.
Caudarella R, Rizzoli E, Buffa A, Bottura A & Stefoni S (1998): Comparative study of the influence of 3 types of mineral water in patients with idiopathic calcium lithiasis. J. Urol. 159, 658–663.
Coen G, Sardella D, Barbera G, Ferrannini M, Comegna C, Ferazzoli F, Dinnella A, D'Anello E & Simeoni P (2001): Urinary composition and lithogenic risk in normal subjects following oligomineral versus bicarbonate-alkaline high calcium mineral water intake. Urol. Int. 67, 49–53.
Couzy F, Kastenmayer P, Vigo M, Clough J, Munoz-Box R & Barclay DV (1995): Calcium bioavailability from a calcium- and sulfate-rich mineral water, compared with milk, in young adult women. Am. J. Clin. Nutr. 62, 1239–1244.
Curhan GC, Willett WC, Rimm EB & Stampfer MJ (1993): A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N. Engl. J. Med. 328, 833–838.
Curhan GC, Willett WC, Speizer FE, Spiegelman D & Stampfer MJ (1997): Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann. Intern. Med. 126, 497–504.
Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährungsforschung, Schweizerische Vereinigung für Ernährung (German, Austrian and Swiss Societies of Nutrition) (2000): Referenzwerte für die Nährstoffzufuhr (Reference values for nutritient intake ). Frankfurt: Umschau Braus.
Graham LA, Caesar JJ & Burgen ASV (1960): Gastrointestinal absorption and excretion of Mg28 in man. Metab. Clin. Exp. 9, 646–659.
Hesse A, Tiselius HG & Jahnen A (2002): Urinary Stones. Diagnosis, Treatment, and Prevention of Recurrence, 2nd Edition. Basel: Karger.
Keßler T & Hesse A (2000): Cross-over study of the influence of bicarbonate-rich mineral water on urinary composition in comparison with sodium potassium citrate in healthy male subjects. Br. J. Nutr. 84, 865–871.
Keßler T & Hesse A (2002): Effect of blackcurrant-, cranberry- and plum juice consumption on risk factors associated with kidney stone formation. Eur. J. Clin. Nutr. 56, 1020–1023.
Kohri K, Garside J & Blacklock NJ (1988): The role of magnesium in calcium oxalate urolithiasis. Br. J. Urol. 61, 107–115.
Li MK, Blacklock NJ & Garside J (1985): Effects of magnesium on calcium oxalate crystallization. J. Urol. 133, 123–125.
Liebman M & Costa G (2000): Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads. J. Urol. 163, 1565–1569.
Marangella M, Vitale C, Petrarulo M, Rovera L & Dutto F (1996): Effects of mineral composition of drinking water on risk for stone formation and bone metabolism in idiopathic calcium nephrolithiasis. Clin. Sci. 91, 313–318.
Massey LK & Kynast-Gales (1998): Substituting milk for apple juice does not increase kidney stone risk in most normocalciuric adults who form calcium oxalate stones. J. Am. Diet. Assoc. 98, 303–308.
Nicar MJ, Hill K & Pak CYC (1987): Inhibition by citrate of spontaneous precipitation of calcium oxalate in vitro. J. Bone Miner. Res. 2, 215–220.
Quamme GA (1993): Magnesium homeostasis and renal magnesium handling. Miner. Electrolyte Metab. 19, 218–225.
Reungjui S, Prasomgwatana V, Premgamone A, Tosukhowong P, Jirakulsomchok S & Sriboonlue P (2002): Magnesium status of patients with renal stones and its effect on urinary citrate excretion. BJU Int. 90, 635–639.
Rodgers AL (1997): Effect of mineral water containing calcium and magnesium on calcium oxalate urolithiasis risk factors. Urol. Int. 58, 93–99.
Sabatier M, Arnaud MJ, Kastenmayer P, Rytz A & Barclay DV (2002): Meal effect on magnesium bioavailability from mineral water in healthy women. Am. J. Clin. Nutr. 75, 65–71.
Simpson DP (1983): Citrate excretion: a window on renal metabolism. Am. J. Physiol. 244, 223–234.
Werness PG, Brown CM, Smith LH & Finlayson B (1985): EQUIL2: a basic computer program for the calculation of urinary saturation. J. Urol. 134, 1242–1244.
About this article
Cite this article
Siener, R., Jahnen, A. & Hesse, A. Influence of a mineral water rich in calcium, magnesium and bicarbonate on urine composition and the risk of calcium oxalate crystallization. Eur J Clin Nutr 58, 270–276 (2004). https://doi.org/10.1038/sj.ejcn.1601778
This article is cited by
Fluid intake recommendations in urolithiasis and general advice to patients without metabolic risk factors
World Journal of Urology (2023)
World Journal of Urology (2023)
The effects of drinking bicarbonate-rich mineral water in calcium oxalate stone formers: an open label prospective randomized controlled study in an Asian cohort
International Urology and Nephrology (2022)
Arabian Journal of Geosciences (2021)