The Health And Economic  Burden of Desalination-Related  Magnesium Deficiency
Creators: name: Sadeh, Maya
name: Grotto, Itamar
name: Davidovitch, Nadav
name: Weinreb, Alex
Publisher: name: The Taub Center for Social Policy Studies in Israel
Year: 2024

description: The prolonged water crisis that Israel suffered from for decades has been curbed thanks to desalination plants, but a side effect of that solution has created an unexpected health problem — a magnesium deficiency.

A new study by the Taub Center, conducted by researchers from the Taub Center Research and Policy Initiative for Environment and Health — Maya Sadeh, Prof. Itamar Grotto, Prof. Nadav Davidovitch, and Prof. Alex Weinreb — examined the health and economic impacts of magnesium deficiency, a mineral critical to human health. The study found that this deficiency increases the prevalence of type 2 diabetes and ischemic stroke. Before the desalination era, natural water provided 10%–20% of magnesium intake in Israel, but in desalinated water — now comprising the water supplied to about 70% of Israel’s households — there is no magnesium at all.

The good news is that this extra burden of disease can be avoided: by adding magnesium back into desalinated water, it is possible to reduce illness rates and save the healthcare system hundreds of millions of shekels. The expected annual savings in direct healthcare expenses from preventing type 2 diabetes and ischemic stroke, resulting from increasing magnesium intake by 50 mg per day, range from NIS 83 to 188 million in 2025 and between NIS 110 to 253 million in 2040. According to a Ministry of Health report, adding magnesium to water would cost about NIS 37 million annually.

The health importance of magnesium

Magnesium plays a crucial role in ensuring the proper functioning of all body organs, including the cardiovascular system, musculoskeletal system, immune system, and digestive system. Some of its functions are even critical to life. Magnesium is also involved in regulating the electrical properties of the heart muscle and suppressing inflammatory mechanisms that prevent vascular calcification and the development of atherosclerosis, thrombosis, and myocardial infarction. It also plays a critical role in regulating calcium and potassium and insulin receptors. Optimal calcium concentration in cells leads to normal blood pressure and prevents, among other things, blood clots and arterial calcification. Too much calcium in cells disrupts cell metabolism, increases insulin resistance, leads to obesity, and raises cases of type 2 diabetes.

Magnesium intake deficiency in IsraelThe recommended daily magnesium intake is 265–315 mg for women and 350–415 mg for men. A deficiency in magnesium intake, primarily due to a diet low in magnesium and magnesium-poor water, affects all age and population groups. The deficiency ranges from 10 mg among Jewish women aged 35–64 to 50%–80% among Arabs and Jews aged 65 and over. A significant deficiency (around 60mg) was found among relatively young Jewish men and women aged 18–34. Among Arab men and women, the deficiency is more pronounced in older age groups, 45–65. According to the researchers, this is concerning because people in this age group are more likely to have medical conditions such as diabetes, which prevent efficient magnesium absorption.

The impact of desalination on magnesium in drinking water and magnesium intakeThe negative outcome of desalination, particularly concerning magnesium deficiency, has been recognized in Israel for some time. Discussions about adding magnesium to desalinated drinking water in Israel began as early as 2004. In 2013, public health protection regulations mandated that the significance and cost of adding magnesium to drinking water at a concentration of 20–30 mg per liter be assessed. A professional committee established by the Ministry of Health determined that reducing morbidity and mortality from type 2 diabetes, coronary heart disease, and ischemic stroke carries significant economic benefits and called for the establishment of a pilot facility to add magnesium to water. However, facilities to add magnesium to drinking water have yet to be established, and it remains unclear if and when this will happen.

Home water filters also significantly reduce magnesium in waterHealth and nutrition surveys by the Ministry of Health show that desalination is not the only factor affecting magnesium intake. The surveys estimate that the daily amount of magnesium consumed through drinking water — assuming an average daily intake of two liters of water per person — is about 65 mg from tap water (not desalinated) and about 56 mg from bottled water. In contrast, the amount of magnesium in filtered water from home filters is zero. Given the widespread use of home water filters in Israel, which stands at about 46% of the population according to this survey, this is a concerning figure that must be considered when examining policy measures to increase magnesium intake in the population.

A suitable and rapid solution is needed to address the magnesium deficiency, especially due to drinking water without magnesium

The researchers present economic estimates indicating that adding 50 mg of magnesium to daily intake could prevent over 1,000 new cases of type 2 diabetes and over 100 new cases of stroke each year. This would result in annual savings of hundreds of millions of shekels for the healthcare system.



The annual health costs per person for type 2 diabetes patients are 1.7–2.7 times higher than for those who do not have diabetes. Estimates show that the amount saved for the healthcare system in 2040 from reducing cases of type 2 diabetes and stroke, given an additional 50 mg of magnesium per day, would range from NIS 111 to 254 million, depending on how successfully the illness is managed and the baseline magnesium intake.

The lifetime cost of treating these extra cases of type 2 diabetes arising from a deficiency of 50 mg of magnesium ranges from NIS 800 million to NIS 2.1 billion, depending on baseline magnesium intake, the per capita treatment cost ratio between diabetes patients and non-patients, and the percentage of patients managing their condition well.

The real cost to society and the economy of treating a type 2 diabetes patient is at least twice that of treating a non-diabetic person, when considering indirect costs such as loss of work capacity, sick days, additional treatments, caregiver family costs, and disability pensions from the National Insurance Institute.


The risk of diabetes in Israel is higher among socioeconomically disadvantaged populations. The study also notes that baseline magnesium intake through diet and supplement consumption is lower among these populations compared to higher socioeconomic groups. Therefore, the lack of magnesium in drinking water exacerbates health inequality.