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Forty seven percent of the population of Pakistan is food insecure, access to food is uneven and malnutrition is widespread. In addition, food production depends greatly on irrigation, including the use of substantial volumes of water from already stressed aquifers. Our aim in this paper is to examine the implications of continued population growth on the required production of food and the implied water demand. We examine the historical trends of crop production, water use, food availability and population growth in Pakistan, and project them forward to 2050. Food availability has improved over recent decades, mostly as a result of increasing the area and water use of crops and fodder, and partly as a result of importing more pulses and cooking oils. We show that a continuation of current trends leads to nearly a doubling of the (already unsustainable) groundwater use. There is uncertainty in the magnitude of climate change impacts, but climate change may further exacerbate matters. To avoid further increases of groundwater use, some combination would be required of: more dams and other irrigation infrastructure; increasing crop yields (particularly yields per unit volume of water) at a greater rate than in the past; a change in crop mix away from high water use crops like rice and sugarcane, to crops that use less water; and, exporting less and importing more food. The alternatives appear difficult to implement quickly, so it appears likely that in the short to medium term more groundwater will be consumed, with attendant problems of water quality and sustainability. Our analysis provides new perspectives on past trends and future food and water (including groundwater) challenges. [ABSTRACT FROM AUTHOR]