Francisco Maraver

The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials

The aims of this study were to conduct a systematic literature review on balneotherapy about the specific therapeutic role of mineral elements and other chemical compounds of mineral waters and derivate peloids/muds and to discuss the study methods used to evaluate it (in musculoskeletal conditions). We searched Medline by PubMed using the following key words: “spa therapy” “balneotherapy” “mud” “peloid” “mud pack Therapy” in combination with “randomized controlled trial” “double blind trial.” We also reviewed the reference list of articles retrieved by the Medline search. We selected the double-blind randomized clinical trials that assessed the effects of mineral water or mud treatments compared to tap water, attenuated peloid/mud therapy or similar treatments without the specific minerals or chemical compounds of the treatment group (“non-mineral”). We evaluated the internal validity and the quality of the statistical analysis of these trials. The final selection comprised 27 double-blind randomized clinical trials, 20 related to rheumatology. A total of 1118 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies: 552 of knee osteoarthritis, 47 of hand osteoarthritis, 147 chronic low back pain, 308 of reumathoid arthritis, and 64 of osteoporosis; 293 of these participants were assigned to the experimental groups of knee osteoarthritis, 24 in hand osteoarthritis, 82 of low back pain, 152 with reumathoid arthritis, and 32 with osteoporosis. They were treated with mineral water baths and/or mud/peloid (with or without other forms of treatment, like physical therapy, exercise…). The rest were allocated to the control groups; they received mainly tap water and/or “non-mineral” mud/peloid treatments. Mineral water or mud treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others in some rheumatologic diseases (knee and hand osteoarthritis, chronic low back pain, rheumatoid arthritis, and osteoporosis) compared to baseline and non-mineral similar treatments. Internal validity and other limitations of the study’s methodology impede causal relation of spa therapy on these improvements. Randomized clinical trials are very heterogeneous. Double-blind randomized clinical trials seem to be the key for studying the role of mineral elements and other chemical compounds, observing enough consistency to demonstrate better and longer improvements for mineral waters or derivate compared to tap water; but due to heterogeneity and gaps on study protocol and methodology, existing research is not sufficiently strong to draw firm conclusions. Well-designed studies in larger patients’ population are needed to establish the role of minerals and other chemical compounds in spa therapy.

Magnesium in tap and bottled mineral water in Spain and its contribution to nutritional recommendations

INTRODUCTION An appropriate magnesium intake has proved to have beneficial effects on bone health, reduce insulin resistance and prevent atherosclerosis. OBJECTIVE To determine the concentration of magnesium in drinking water and bottled mineral water in Spain and assess its daily contribution to dietary recommendations. METHODS We used ion chromatography to analyse the magnesium concentrations of public drinking waters in a representative sample of 108 Spanish municipalities (supplying 21,290,707 potential individuals) and 109 natural mineral waters sold in Spain (97 Spanish and 12 imported). RESULTS The water generally contained between 15 and 45 mg/L of magnesium, but in seven municipalities it contained over 45 mg/L. The average magnesium concentration of 97 brands of Spanish natural mineral water was 16.27 mg/L (range: 0.11-141.2 mg/L). Of these, 33 contained between 15 and 45 mg/L of magnesium and four contained over 45 mg/L. Of the 12 imported brands, 4 contained over 45 mg/L. Assuming water consumption is as recommended by the European Food Safety Agency, water containing 15 to 45 mg/L of magnesium provides between 9 and 76.5% of the recommended intake of magnesium for children aged one to thirteen, up to 25.7% in adolescents, between 7.5 and 25.7% for adults, and up to 27% for lactating women. Water with 60 mg/L of magnesium provides between 30 and 102% of the recommended dietary allowance, depending on the age of the individual. DISCUSSION The consumption of public drinking water and natural mineral water in a third of Spanish cities can be regarded as an important supplementary source of magnesium.

The calcium concentration of public drinking waters and bottled mineral waters in Spain and its contribution to satisfying nutritional needs

INTRODUCTION A sufficient intake of calcium enables correct bone mineralization. The bioavailability of calcium in water is similar to that in milk. OBJECTIVE To determine the concentration of calcium in public drinking water and bottled mineral water. METHODS We used ion chromatography to analyse the calcium concentrations of public drinking waters in a representative sample of 108 Spanish municipalities (21,290,707 people) and of 109 natural mineral waters sold in Spain, 97 of which were produced in Spain and 12 of which were imported. RESULTS The average calcium concentration of public drinking waters was 38.96 ± 32.44 mg/L (range: 0.40- 159.68 mg/L). In 27 municipalities, the water contained 50-100 mg/L of calcium and in six municipalities it contained over 100 mg/L. The average calcium concentration of the 97 Spanish natural mineral water brands was 39.6 mg/L (range: 0.6-610.1 mg/L). Of these, 34 contained 50-100 mg/L of calcium and six contained over 100 mg/L. Of the 12 imported brands, 10 contained over 50 mg/L. Assuming water consumption is as recommended, water containing 50-100 mg/L of calcium provides 5.4-12.8% of the recommended intake of calcium for children aged one to thirteen, up to 13.6% for adolescents, 5.8-17.6% for adults, and up to 20.8% for lactating mothers. Water with 100-150 mg/L of calcium provides 10-31% of the recommended dietary allowance, depending on the age of the individual. DISCUSSION Public drinking water and natural mineral water consumption in a third of Spanish cities can be considered an important complementary source of calcium.

Sulphurous Mineral Waters: New Applications for Health

Sulphurous mineral waters have been traditionally used in medical hydrology as treatment for skin, respiratory, and musculoskeletal disorders. However, driven by recent intense research efforts, topical treatments are starting to show benefits for pulmonary hypertension, arterial hypertension, atherosclerosis, ischemia-reperfusion injury, heart failure, peptic ulcer, and acute and chronic inflammatory diseases. The beneficial effects of sulphurous mineral waters, sulphurous mud, or peloids made from sulphurous mineral water have been attributed to the presence of sulphur mainly in the form of hydrogen sulphide. This form is largely available in conditions of low pH when oxygen concentrations are also low. In the organism, small amounts of hydrogen sulphide are produced by some cells where they have numerous biological signalling functions. While high levels of hydrogen sulphide are extremely toxic, enzymes in the body are capable of detoxifying it by oxidation to harmless sulphate. Hence, low levels of hydrogen sulphide may be tolerated indefinitely. In this paper, we review the chemistry and actions of hydrogen sulphide in sulphurous mineral waters and its natural role in body physiology. This is followed by an update of available data on the impacts of exogenous hydrogen sulphide on the skin and internal cells and organs including new therapeutic possibilities of sulphurous mineral waters and their peloids.

Survival of human pathogenic bacteria in different types of natural mineral water.

The aim of this study was to determine the survival of human pathogens (Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa) in five natural mineral waters (NMWs) with different properties and mineralization levels. Five NMWs from four Spanish spas with different dry residue at 110 °C were used: A = 76,935 mg/L; B = 1,827 mg/L; C = 808.4 mg/L; D = 283.8 mg/L; and E = 170.4 mg/L. An initial inoculum of 1 × 10(6) colony forming units (cfu)/mL was used for survival studies. Distilled water, chlorinated tap water and Mueller-Hinton broth were used as controls. Colony counts in all different waters were lower than those achieved with Mueller-Hinton broth over all incubation periods. A direct effect between the bacterial survival and the level of mineralization water was observed. The NMW E with low mineralization level along with the radioactive properties showed the highest antibacterial activity among all NMWs.

Salt water and skin interactions: new lines of evidence

In Health Resort Medicine, both balneotherapy and thalassotherapy, salt waters and their peloids, or mud products are mainly used to treat rheumatic and skin disorders. These therapeutic agents act jointly via numerous mechanical, thermal, and chemical mechanisms. In this review, we examine a new mechanism of action specific to saline waters. When topically administered, this water rich in sodium and chloride penetrates the skin where it is able to modify cellular osmotic pressure and stimulate nerve receptors in the skin via cell membrane ion channels known as “Piezo” proteins. We describe several models of cutaneous adsorption/desorption and penetration of dissolved ions in mineral waters through the skin (osmosis and cell volume mechanisms in keratinocytes) and examine the role of these resources in stimulating cutaneous nerve receptors. The actions of salt mineral waters are mediated by a mechanism conditioned by the concentration and quality of their salts involving cellular osmosis-mediated activation/inhibition of cell apoptotic or necrotic processes. In turn, this osmotic mechanism modulates the recently described mechanosensitive piezoelectric channels.

Nicotine traces detected in bottled mineral water.

Acetaminophen 33 4 Antipyrine 16 2 Atenolol 6 1 Bezafibrate 8 1 Caffeine 15 4 Carbamaz.10,11-epoxide 18 1 Ciprofloxacin 10 6 Diazepan 3 1 Erythromycin 99 1 Fenofibrate 4 2 Fluoxetine 3 1 Furosemide 160 2 Indomethacine 4 1 Ketoprofen 105 2 Mefenamic Ac 3 2 Mepivacaine 6 2 Metoprolol 14 1 Metronidazole 17 3 Naproxen 24 14 Nicotine 72 4 Ofloxacin 33 3 Omeprazole 6 1 Paraxanthine 55 3 Paroxetine 14 2 Propanolol 4 1 Ranitidine 153 2 Salbutamol 4 1 Sotalol 12 2 Sulfamethoxazole 9 1 Trimethoprim 29 2 Carbamazepine 1 1 Codeine 10 125 Gemfibrozil 0.1 7 Hydrochlorothiazide 2 7 Ibuprofen 4 7

Análisis de las aguas minerales de la provincia del Neuquen, República Argentina

espanolLa provincia del Neuquen tiene un origen geologico volcanico, es uno de los territorios argentinos con mas recursos hidrotermales descubiertos, en su gran mayoria de tipo magmatico meteorico aunque tambien cuenta con aguas que provienen de una cuenca mesozoica receptora de depositos marinos permitiendo mediante perforacion encontrar depositos de aguas juveniles. El objetivo del trabajo ha sido realizar el estudio analitico de las caracteristicas fisico quimicas de las aguas minerales de la provincia. Los parametros analizados han sido los necesarios para la clasificacion de las aguas desde el punto de vista de la Hidrologia Medica. Tambien se han determinado otros parametros necesarios para el conocimiento de la calidad del analisis siguiendo las indicaciones del Standard Methods. La seleccion de los manantiales se ha realizado teniendo en cuenta el caudal, la accesibilidad, la autorizacion para acceder a los mismos, asi como su viabilidad de actividad futura. Reune el analisis de dieciocho aguas, en su gran mayoria hipertermales, de fuerte mineralizacion, y si bien predominan las aguas sulfatadas tambien encontramos cloruradas, bicarbonatadas y carbogaseosas, destacando por su importancia las del area geotermal de Copahue. EnglishThe province of Neuquen is of volcanic origin, it is one of the Argentine territories with more hydrothermal resources discovered, the great majority of meteoric magmatic type. The objective of the work has been to carry out the analytical study of the physical chemical characteristics of the mineral waters of the province. The analyzed parameters were those necessary for the classification of the waters from the point of view of Medical Hydrology. Other parameters necessary to know the quality of the analysis have also been determined following the instructions of the Standard Methods. The selection of springs has been done taking into account the flow, accessibility, authorization to access them, as well as their feasibility for a future activity. The paper compiles the analyzes of eighteen waters, most of them hyperthermal, with strong mineralization, predominating sulphate waters. There are also chlorides, bicarbonated and carbon dioxide waters, emphasizing for their importance those of the geothermal area of Copahue.

Therapeutic Effects of the Mineral Waters from Copahue Spa

Nestled in the Andes of Argentina, the Copahue village owes its name to the nearby volcano and boasts an exceptional climate along with several hydrothermal resources. The most outstanding of these resources are its mineral waters (sulphated, sulphurated, carbogaseous, ferruginous and bicarbonated) and their derived products including sulphurated muds, thermophilic algae and sulphurated gases. All these resources are used as natural remedies to treat rheumatic, skin, respiratory and neurological diseases.

Las aguas que fueron

Un sentido analitico acompana constantemente a la humanidad en su proceso continuo de perfeccion. Separar y aislar es un evidente rasgo de inteligencia que se ha manifestado desde la mas remota antiguedad. Cuando el hombre se enfrenta al vasto campo de la diversidad del mundo natural, de forma instintiva divide esta diversidad en grupos mas pequenos para hacerlos manejables. La clasificacion es el metodo basico que el hombre emplea para enfrentarse al mundo que le rodea. El analisis y la clasificacion fueron tambien utilizados por los hidrologos, desde los primeros tiempos para ordenar y dar nombre a las diferentes aguas. Actualmente clasificamos como aguas mineromedicinales oligominerales a las que tienen un residuo seco inferior a 1g/l. A las que tienen un residuo seco igual o superior a 1g/l las clasificaremos como aguas cloruradas, bicarbonatadas, sulfatadas; pudiendo ser, sodicas, calcicas y magnesicas. Por sus elementos especiales podran ser tambien ferruginosas, carbogaseosas, sulfuradas y radiactivas. Aunque con distintos nombres estos elementos han sido tenidos en cuenta desde las primeras clasificaciones, pero ademas se han clasificado las aguas en funcion de otras sustancias a lo largo del tiempo. En la Tabla 1 reunimos estos tipos de aguas segun los principales hidrologos espanoles. En orden alfabetico trataremos las aguas con las sustancias que sirvieron para clasificarlas en otras epocas y sus posibles acciones terapeuticas.