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Fluoride part 2

CHALLENGING THE PRO-FLUORIDATION MANTRA, part 2.
Introduction.

Promoters of fluoridation repeat ad nauseam the mantra that fluoridation is “safe”, “effective” and “cost effective.” In part 2 I discuss the 6 KEY PAPERS that challenge the mantra of fluoridation’s “safety.” Or to be more precise – since there is no question that fluoride is very toxic and damages health – we will demonstrate that there is no adequate margin of safety to protect all citizens drinking artificially fluoridated water (and getting fluoride from other sources) from known health effects.

STUDIES ON THE TOXICITY OF FLUORIDE AND SAFETY OF FLUORIDATION

5. National Resource Council of the National Academies. 2006. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.

A landmark report on the toxicology of fluoride is available to read and search for free online. It is one of the very few reviews of fluoride for which the panel was balanced. It contained both pro and anti-fluoridation scientists. The report concluded that the current U.S. maximum contaminant level for fluoride (4 ppm) in drinking water is an unsafe level for human health. The panel recommended that the EPA conduct a new risk assessment to establish a goal for a safe level of fluoride in drinking water (Maximum Contaminant Level Goal, MCLG) and thence a new Federally enforceable standard (or MCL). After over 8 years the EPA has not completed this determination and so for 8 years the US continued to operate under unsafe standards for fluoride in water.

BONE DAMAGE. Among many health concerns the panel noted that fluoride damages the bone and accumulates there with a significantly long half-live. The first symptoms of bone damage are indistinguishable from arthritis and with further accumulation (fluoride’s half life in bone is at least 20 years) it makes the bones more brittle and prone to fracture.

ENDOCRINE DISRUPTER. The panel also concluded that fluoride is an endocrine disrupter. It lowers thyroid function and accumulates in the pineal gland (see paper 6 below).

NEUROTOXICIY.  Many animal studies indicate that fluoride can enter and damage the brain via a number of mechanisms. At thetime this review was published only 5 IQ studies were available. Since publication this total has risen dramatically. Including new studies and older Chinese studies that have been translated by FAN, there are now (as of Dec 2014) 49 studies, of which 42 show an association between exposure to fairly modest doses of fluoride and lowered IQ (see papers 7-9 below). For those who want more details of all the animal and human studies on fluoride’s toxicity see FAN’s health database

OSTEOSARCOMA.At the time of publication the NRC panel had been informedbyFAN of a doctoral thesis by Elise Bassin from Harvard, whichindicated an association between exposure to fluoridated water at a critical age range in young boys (6-8 years) and succumbing by the age of 20, to osteosarcoma, a frequently fatal bone cancer. The NRC did not take a definitive position on this study preferring to wait for the study to be published. Bassin’s publication came in May of 2006 (discussed below, see paper 10). However the same edition of the journal also contained a letter from her pro-fluoridation thesis advisor Chester Douglass claiming that his larger study would show that her thesis did not hold. However, he has never published this promised rebuttal of her thesis.

Subsets of US population exceeding EPA’s safe reference dose. While the NRC review did not study fluoridation as such (either its risk or benefits), the authors did provide an exposure analysis (see Chapter 2). The panel showed that several subsets of the population drinking fluoridated water at 1 ppm fluoride (including bottle-fed infants) are exceeding the EPA’s safe reference dose of 0.06 mg/kg/day (see the diagram on page 85). This finding makes nonsense of the claim by both ADA and the CDC that this very important review was not relevant to water fluoridation.

No margin of safety. Based on this review it is abundantly clear that fluoride damages health and that for several end-points (including lowered IQ), there is no adequate margin of safety to protect all individuals in a large population drinking fluoridated water. This critical conclusion is often lost on promoters of fluoridation who confuse concentration with dose. They simplistically compare the concentration of fluoride in the water of the community examined with the concentration of fluoride in artificially fluoridated water. Such a comparison does not provide a margin of safety. For that one needs two things:

First, one has to ascertain the range of dosesin the fluoridated population. This takes into account how much water citizens drink (which can be very large because there is no control on the amount of water consumed) and how much fluoride they get from other sources.

Second, in order to determine a safe dose (sufficient to protect everyone) one also has to take into account the full range of sensitivity to a toxic substance anticipated in a large population. It is the failure to do this that has been the biggest and most reckless mistake of the fluoridation program since it began and fluoridation promoters today.

6. Luke J. 2001. Fluoride Deposition in the Aged Human Pineal Gland.Caries Research 35(2):125-128. See also Luke’s PhD thesis click here.

Luke showed that fluoride accumulates on the calcified deposits in the human pineal gland and lowers melatonin production in animals. No health agency in any fluoridating country has attempted to repeat Luke’s work despite the fact that melatonin levels have been related to many health problems. For example, Autistic children produce no melatonin.

7. Xiang Q, Liang Y, Chen L, et al. 2003a. Effect of fluoride in drinking water on children’s intelligence. Fluoride 36(2):84-94, and Xiang Q, Liang Y, Zhou M, and Zang H. 2003b. Blood lead of children in Wamiao-Xinhuai intelligence study [letter]. Fluoride 36(3):198-199.

Of the 42 (out of 49) studies (as of Dec 2014) that have found a relationship between fluoride exposure and lowered IQ, the Xiang study is one of the most important.

In the Xiang study, the authors controlled for key confounding values such as lead, and iodine (and arsenic retrospectively), parental income and educational status. In addition to comparing the mean IQ of children between the high-fluoride and low-fluoride village (a drop of 5-10 IQ points across the whole age range) they also sub-divided the children in the high-fluoride village into 5 groups with mean fluoride concentrations ranging from 0.7 to 4.3 ppm (see Table 8 in their study).

By focusing on one village they eliminated any other environmental differences between the two villages. They found that as the fluoride concentration in the five sub-groups increased two things happened: 1) the mean IQ systematically decreased and 2) the percentage of children with an IQ less than 80 (borderline mentally handicapped) dramatically increased from 0% to 37.5%.

Lowest level where IQlowered. The lowering of IQ is first observed in the sub-group at 1.53 ppm, and bearing in mind the range of fluoride concentration for that sub-group, one has to conservatively assume that some children in this study would have had their IQ lowered at the lower end of the range fluoride concentrations in this group 1.26 ppm.

Such a result leaves absolutely no margin of safety to protect all children in an artificially fluoridated community (fluoride levels between 0.7 to 1.2 ppm) from this serious outcome. Please note there is no margin of safety to protect:

A) Against the full range of exposure, especially when you consider the different amounts of water drunk by children and their exposure to other sources such as toothpaste. It should also be added that in two respects the Chinese children in the Xiang study would have had less exposure to fluoride from two key sources than American children. Children living in rural Chinese villages are less likely to be using fluoridated toothpaste and less likely to be bottle-fed (bottle-fed babies, where the formula is made up with fluoridated water, get about 200 times more fluoride than breast-fed babies).

B) Nor does it protect against the full range of sensitivity expected in a large population (as discussed in 5 above).

The last children that need a further lowering of IQ are children from low-income families, whose IQ has already been compromised by so many other factors (e.g. poorer diet, poorer educational opportunities and more exposure to pollution). Yet it is these children who are the primary target of fluoridation programs.

8. Choi AL, Sun G, Zhang Y, Grandjean P. 2012. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environmental Health Perspectives, 120(10):1362–1368.

This Meta-analysis of 27 IQ studies was conducted by a team from Harvard including world-famous neuroscientist Philippe Grandjean (an expert on mercury and author of the recent book, “Only One Chance”). This team acknowledged weaknesses in many of the studies but also noted the remarkable consistency of the finding that IQ was lowered in 26 out of the 27 studies reviewed. The average lowering was 7 IQ points, which is substantial, considering that at the population level even an average lowering of one IQ should be avoided.

9. Choi AL, Zhang Y, Sun G, et al. 2015. Association of lifetime exposure to fluoride and cognitive functions in Chinese children: A pilot study.Neurotoxicology and Teratology, 47:96–101.

This Pilot study in China was carried out at fluoride levels, which overlap levels used in US fluoridation programs. They didn’t measure IQ specifically in this study but reported the results of a very simple test: the child’s ability to repeat a sequence of numbers both forwards and backwards. Even children with very mild dental fluorosis performed less well on this specific mental development test, than children without fluorosis. One of the experts involved in this study was Dr. David Bellenger who is world famous for his studies on lead’s neurotoxicity.

Another co-author was Dr. Philippe Grandjean and in an editorial on his website “Chemical Brain Drain”he used this study to counteract the claim from proponents that the IQ findings were not relevant to the fluoride levels used in water fluoridation. For the children in this study, Grandjean writes:

“Their lifetime exposures to fluoride from drinking water covered the full range allowed in the US. Among the findings, children with fluoride-induced mottling of their teeth – even the mildest forms that appears as whitish specks on the enamel – showed lower performance on some neuropsychological tests. This observation runs contrary to popular wisdom that the enamel effects represent a cosmetic problem only and not a sign of toxicity. At least one of five American children has some degree of mottling of their teeth…Prevention of chemical brain drain should be considered at least as important as protection against caries.” (my emphasis, PC).

10. Bassin EB, Wypij D, Davis RB, Mittleman MA. 2006. Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes and Control, May;17(4):421-8.

This is the only study of osteosarcoma (a frequently fatal bone cancer in children), which studied the age at which exposure to fluoride was experienced. The authors write:

We observed that for males diagnosed before the age of 20 years, fluoride level in drinking water during growth was associated with an increased risk of osteosarcoma, demonstrating a peak in the odds ratios from 6 to 8 years of age. All of our models were remarkably robust in showing this effect, which coincides with the mid-childhood growth spurt.

The finding that there may a critical window of vulnerability in young men has never been refuted – or even investigated – since Bassin’s paper was published in 2006. The shocking fact is that with this paper comes the possibility that a few young men each year may be dying from osteosarcoma because they have been exposed to fluoridated water at a critical age. Even though this has not been refuted the practice of fluoridation continues to be pushed by health authorities. Where is the precautionary principle here?

Conclusion:

Between them the TEN KEY PAPERS (listed in part 1) invalidate all three claims of the pro-fluoridation mantra.

Fluoridation is not effective.

 The largest US study (Brunelle and Carlos, 1990) and the most precise study of children’s tooth decay (Warren et al., 2010) provide little evidence that swallowing fluoride reduces tooth decay. Featherstone, 2000 (and others) have provided the probable reason for these problematic results. The predominant (if any) benefit of fluoride is topical not systemic. There is no need to swallow fluoride to fight tooth decay and there is no justifiable reason to force people to drink fluoridated water against their will.

Fluoridation is not safe.

There is no disputing the fact that fluoride damages health but what about fluoridation? The landmark 500-page review by the National Research Council (NRC, 2006) showed that certain subsets of the US public are exceeding the EPA’s safe reference dose for fluoride, including bottle-fed infants. The NRC (2006) reviewed many health impacts for which there is no adequate margin of safety to protect all individuals drinking fluoridated water. These include lowered thyroid function, accumulation in the pineal gland (Luke et al., 2001), bone damage, and lowered IQ (Xiang at al, 2003a,b). Xiang found that some children had their IQ lowered at fluoride levels as low as 1.26 ppm. Xiang’ study was one of 42 studies that have found this effect. A Review by a Harvard team (Choi et al, 2012) found an average lowering of 7 IQ points in 26 out of 27 studies. Choi et al, 2015 found learning disabilities in children with very mild fluorosis, which impacts many US children. Thus fluorosis at any level can no longer be considered merely a cosmetic affect. A study by Bassin et al., 2006 has disturbingly shown that some young boys may be losing their lives each year from being exposed to fluoridated water at 1 ppm in their 6th, 7th and 8th years. This study remains unrefuted.

Fluoridation is not cost-effective.

Lo and Thiessen(2014) have demolished the claim by CDC economist Susan Griffin that for every dollar spent on fluoridation $38 is saved on dental treatment. This claim by Griffin has been used Ad Nauseam by promoters of fluoridation including many state public health officials. Will they continue to do so? 

Paul Connett, PhD
Director
Fluoride Action Network
Co-Author of The Case Against Fluoride (Chelsea Green, 2010)

See Bulletin Online

Fluoride Resource studies


Ten Key Papers that Challenge the Pro-fluoridtion Mantra

Introduction 

Promoters of fluoridation repeat ad nauseam the mantra that fluoridation is “safe”, “effective” and “cost effective” (how many times have unsuspecting legislators been told that for every $1 spent we save $38?). Instead of backing up these claims with any solid scientific evidence, they use a long list of impressive but fairly meaningless (i.e. “science-free”) endorsements. This is not surprising because the science is not there to support the mantra. What is surprising is that public health officials and professional bodies repeat these claims with no sense of embarrassment. I believe that historians will be astounded that so many “respectable” professional associations and health agencies (in the handful of countries that fluoridate) have endorsed a practice, which has such little scientific and no ethical justification. In Orwell’s Animal Farm the pigs rule, in the fluoridated world the sheep rule.

Below is a list of 10 studies (actually nine studies and one review) that invalidate this mantra.  Fluoridation is neither effective, nor safe, nor cost-effective. In addition I give a few words about the first four studies that challenge the mantra of fluoridation’s “effectiveness” and  “cost-effectiveness.”

In part 2 of this article, I will say a few words on the papers that pertain to safety.

Part 1. A Listing of the 10 studies

1. Brunelle and Carlos. 1990. Recent Trends in DentalCaries in U.S. Children and the Effect of Water Fluoridation. Journal of Dental Research,69(Special Issue):723-727.

2. Featherstone JD. 2000.The Science and Practice of Caries Prevention. Journal of the American Dental Association (JADA), Jul; 131(7):887-99.

3. Warren JJ, et al. 2009. Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes–a longitudinal study. Journal of Public Health Dentistry, 69(2):111-15. Spring.

4. Ko L, Thiessen KM. 2014. A critique of recent economic evaluations of community water fluoridation. International Journal of Occupational and Environmental Health.

5. Luke J. 2001. Fluoride deposition in the aged human pineal gland. Caries Research 35(2):125-128. See also Luke’s PhD thesis click here.

6. Xiang Q, et al. 2003a. Effect of fluoride in drinking water on children’s intelligence. Fluoride 36(2):84-94, and Xiang Q, et al. 2003b. Blood lead of children in Wamiao-Xinhuai intelligence study [letter]. Fluoride 36(3):198-199.

7. National Resource Council of the National Academies. 2006. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.

8. Bassin EB, et al. 2006. Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes and Control, May;17(4):421-8.

9. Choi AL, Grandjean P, et al. 2012. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environmental Health Perspectives, 120(10):1362–1368.

10. Choi AL, et al. 2015. Association of lifetime exposure to fluoride and cognitive functions in Chinese children: A pilot studyNeurotoxicology and Teratology, 47:96–101.

A few words about papers 1-4.

STUDIES ON EFFECTIVENESS OF FLUORIDATION

1. Brunelle and Carlos. 1990.Recent Trends in DentalCaries in U.S. Children and the Effect of Water Fluoridation. Journal of Dental Research,69 (Special Issue):723-727.

This was the largest survey of dental decay in children in the US (the authors studied 39,000 children in 84 communities). The study was organized by the pro-fluoridation National Institute for Dental Research (NIDR). These NIDR authors found an average difference of only 0.6 of one tooth surface between children (aged 5-17) who lived all their lives in a fluoridated community compared to a non-fluoridated community (see Table 6). This result was NOT shown to be statistically significant. The pro-fluoridation bias of the authors becomes apparent in the way they present these unimpressive results in their abstract. They do not report the difference in tooth decay as an absolute value (i.e. 0.6 of one tooth surface) but as a relative % difference. This value of 18% looks more impressive than an absolute saving of 0.6 of about 100 tooth surfaces in a child’s mouth (there are 128 when all the teeth have erupted). Nor did the authors admit that they had not shown that this result was statistically significant: it wasn’t! Here is an excerpt from their abstract, which says more about the politics of this issue than the science.

“Children who had always been exposed to community water fluoridation had mean DMFS (decayed missing and filled surfaces, PC) about 18% lower than those who had never lived in a fluoridated communities. When some of the “background” effect of topical fluoride was controlled, this difference increased to 25%. The results suggest that water fluoridation has played a dominant role in the decline in caries and must continue to be a major prevention methodology.” (my emphasis, PC)

Really?

2. Featherstone JD. 2000.The Science and Practice of Caries Prevention. Journal of the American Dental Association (JADA), Jul; 131(7):887-99.

In this article, which was a cover story in JADA edition of July 2000, Featherstone reached the same conclusions that many prominent dental researchers had reached over the previous 20 years: Namely, that the predominant mechanism of fluoride’s beneficial action is topical not systemic. The CDC acknowledged the same thing in 1999. In other words you don’t have to swallow fluoride to protect your teeth and therefore there is no need to force it on people who don’t want it via their drinking water. This is probably one of the reasons why, according to the World Health Organizations data online, that tooth decay rates in 12-year-olds have been declining at about the same rates in non-fluoridated as in fluoridated countries since the 1960s (http://fluoridealert.org/issues/caries/who-data/ ). Here are Featherstone’s conclusions:

CONCLUSIONS:

Fluoride, the key agent in battling caries, works primarily via topical mechanisms: inhibition of demineralization, enhancement of remineralization and inhibition of bacterial enzymes.

CLINICAL IMPLICATIONS:

Fluoride in drinking water and in fluoride-containing products reduces caries via these topical mechanisms.

3. Warren JJ, Levy SM, Broffitt B. et al. 2009. Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes–a longitudinal study. Journal of Public Health Dentistry, 69(2):111-15. Spring.

If the Brunelle and Carlos (1990) paper was the largest US government funded study, the Warren et al (2009) paper was the most precise. This investigation was conducted as part of the “Iowa study,” which has been examining tooth decay in a cohort of children since birth. Warren et al. examined tooth decay as a function of daily ingestion of fluoride in mg/day (i.e. they examined individual exposure rather than the traditional way of comparing dental decay rates between communities with different concentrations of fluoride in water). The authors could not determine a clear relationship between caries experience and daily dose in mg/day. The authors’ state:

These findings suggest that achieving a caries-free status may have relatively little to do with fluoride intake, while fluorosis is clearly more dependent on fluoride intake.

CONCLUSIONS: Given the overlap among caries/fluorosis groups in mean fluoride intake and extreme variability in individual fluoride intakes, firmly recommending an “optimal” fluoride intake is problematic.

Please note that all three of these studies were carried out by pro-fluoridation dental researchers. Many dentists are oblivious of the fact that research carried out by their own pro-fluoridation colleagues has undermined the effectiveness that they claim. In addition it should be noted that in the 70 years since fluoridation was launched in 1945 there has never been a Randomized Control Trial (RCT) to establish in a scientific fashion that swallowing fluoride lowers tooth decay. This is the gold standard used by the FDA to establish the efficacy of any drug. Considering such a flimsy scientific basis for the effectiveness of this practice it is the height of arrogance to force a known toxic substance on people who don’t want it.

STUDIES ON THE COST-EFFECTIVENESS OF FLUORIDATION

4. Ko L, Thiessen KM. 2014. A critique of recent economic evaluations of community water fluoridation. International Journal of Occupational and Environmental Health.

This paper demolished the claim by Susan Griffin (an economist at the CDC) that for every dollar spent on fluoridation $38 was saved on dental costs. This statement has been used countless times by state dental directors, public health officials and other promoters of fluoridation.  We have provided more details on this in a previous bulletin.

In part 2, I will say a few words about papers 5-10 that challenge the mantra of fluoridation’s “safety.”

Paul Connet, PhD
Director
Fluoride Action Network