What about the fluoride debate?

Like many of you, I have been concerned about several issues in the current debate about fluoride in our country and especially the Salina Kansas water supply. As an educator in wholistic health with a Bachelor’s Degree in Nursing Science from the University of Kansas School of Medicine and a Master’s Degree in Mental Health Nursing from the University of Kansas Graduate School and as a former Mayor and member of the Salina, Kansas, City Commission with the time available for extended research of the matter, I consider myself obligated to do so.

Here’s what I found regarding my areas of concern.

1. Pregnancy and fluorides: no problems found. “The results of several epidemiological studies on the possible adverse effects of fluoride in drinking-water on pregnancy outcome indicate that there is no apparent relationship between the rates of Down syndrome or congenital malformation and the consumption of fluoridated drinking-water (IPCS, 1984, 2002; US EPA, 1985a;Janssen et al., 1988).“ from 1996 World Health Report . And from the 2006 World Health Report “Studies on the association between exposure of mothers to fluoride in drinking-water and adverse pregnancy outcome have shown no increased risk of either spontaneous abortion or congenital malformations. No reasonable evidence of effects on the respiratory, haematopoietic, hepatic or renal systems have emerged from studies of occupationally exposed populations that could be attributed specifically to fluoride exposure. In addition, such studies have failed to produce convincing evidence of genotoxic effects. The majority of fluoride is excreted via the kidneys (USNRC, 1993). Thus it is reasonable that those with impaired renal function might be at greater risk of fluoride toxicity than those without. In discussing this point, WHO (1996) concluded that the data were too limited to permit any quantitative evaluation of possible increased sensitivity due to impaired kidney function. Research results varied pro and con as to whether baby’s teeth were protected by mother’s prenatal water fluoride supplementation, however a study on supplementation of mother’s fluoride intake from 4 months to birth in low fluoride areas did show baby’s bones were stronger than those who did not receive the supplement.  (Unfortunately the internet address for this study was lost.)

Babies formula should not be made with fluoridated water since they drink so much in relation to body size. Breast feeding for the first 6 months is advised. Toddlers should not use fluoridated tooth paste for the same reason. Children up to age 6 should use only a pea sized gob of fluoridated tooth paste and encouraged not to swallow it. These measures help reduce the incidence of little white spots, fluorosis in their teeth and bones. (Brown discoloration is from high levels of fluoride, from fever or other conditions.)

2. The report from China on children’s I.Q. has some positive relevance to Salina. The control areas had water from .34 to 1.0 mg fluoride levels compared to Salina’s .75 to 1mg/liter which keeps Salina in the good area. One study of low iodine plus fluoride at .88 did show lower I.Q., however another study with high fluoride and high iodine showed no difference with the control group. Many inland areas of the U.S. need to use iodized salt in cooking. Salina, Ks., water report did not show iodine content, so iodized salt may be recommended for us also. 

  1. A review of the China studies at http://www.ncbi.nlm.nih.gov/pubmed/22820538 concluded:

“The results support the possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment. Future research should include detailed individual-level information on prenatal exposure, neurobehavioral performance, and covariates for adjustment.”

3. Arsenic…in one form is used to kill cancer cells, it is found in natural sources of water flowing through rock, no studies show it harmful in the level in Salina water of 2.5 ppb, that is two and a half micrograms, not milligrams, in about a quart (liter) of water. (I’m told that a milligram is about 1/8000th of a teaspoonful and it takes 1000 micrograms to make a milligram.) One of the Chinese studies showed arsenic and .2 to 1.1 low fluoride was better for I.Q. than the area of 3.8-11.5 high fluoride. Areas having coal burning and aluminum with high fluoride water also had ill effects on I.Q. I would avoid cooking in aluminum and would work to decrease levels of contamination from burning coal. Neurotoxicity report in

  1. Neurotoxicity at environmental levels of exposure: http://www.ncbi.nlm.nih.gov/pubmed/21679971

    J Neurol Sci. 2011 Sep 15;308(1-2):9-15. doi: 10.1016/j.jns.2011.05.020. Epub 2011 Jun

    Developmental aspects of environmental neurotoxicology: lessons from lead and polychlorinated biphenyls.

    The particular vulnerability of the developing nervous system for low-level exposure to chemicals is well established. It has been argued that some degree of developmental neurotoxicity was found for a large number of industrial chemicals. However, for only few of these, namely inorganic lead, arsenic, organic mercury and polychlorinated biphenyls (PCBs), human evidence is available to suggest that these may cause neurodevelopmental adversity and may, thus, be involved in contributing to neurodevelopmental disorders like autism, attention-deficit disorder, mental retardation or cerebral palsy. The focus of this overview is on PCBs and inorganic lead as developmental neurotoxicants at environmental levels of exposure.” PCB’s and lead were related to ADHD.

  2. http://www.ncbi.nlm.nih.gov/pubmed/22820538 2012 review of fluoride and neurotoxicity acknowledges possible deficits due to high level of fluoride exposure and recommends further testing with individual assessments of exposure.http://www.ncbi.nlm.nih.gov/pubmed/22820538

4. Fluoride is a negative ion substance and highly reactive. That helps it bind to calcium which even helps repair very early decay, to make less porous enamel which is less likely to decay, and helps in bone formation and rebuilding. It is an anti-bacterial and helps fend off the acid activity of bacteria that cause tooth decay. Fluoride added to water at the 1 mg/l level reduces decay about 1/2 compared to levels of .1mg/l. Oxygen also has a negative ion. A person breathing 100% oxygen will have impaired breathing and in cases of severe heart problems the oxygen free radicals can harm the heart muscle. In my pharmacy studies, I learned there is what is called a “Therapeutic Window,” and either too little or too much of anything can be unhealthy.

5. Fluorides in food. Fruits and vegetables are low in fluoride. The food of most concern is rice and barley. Arsenic is also found in rice. “So what’s a parent to do? To reduce arsenic risks, we recommend that babies eat no more than 1 serving of infant rice cereal per day on average. And their diets should include cereals made of wheat, oatmeal, or corn grits, which contain significantly lower levels of arsenic, according to federal information.” exerpt and more information are found at

http://consumerreports.org/cro/magazine/2012/11/arsenic-in-your-food/index.htm

6. Hip fractures were more common in people who had low body weight and or were physically inactive. Estimated average lifetime exposure to fluoride in drinking water ranged from 0.15 to 1.79 ppm. “There is a low risk of hip fracture for people ingesting fluoride in drinking water at concentrations of about 1 ppm. This low risk should not be a reason for withholding fluoridation of water supplies.” according to http://www.ncbi.nlm.nih.gov/pubmed/10675073   I interpret this as those having more and those having less were at higher risk of hip fracture.

7. Sodium Hexafluorosilicate dissolves nearly 100% into fluoride and is not a problem in the normal ph of drinking water. “At equilibrium, the hexafluorosilicate remaining in drinking water is estimated to be <<1 parts per trillion (Urbansky and Schock, 2000). In addition, exposure to impurities in the fluoridating agent is judged to be of low health risk when properly treated water is ingested.” It can be a problem for those who inhale the dust or get it on their skin in concentrated amounts. 1996 World Health Report

8. Accumulation of fluoride in body occurs in teeth and bone primarily and is excreted in the urine. “Approximately 75–90 per cent of ingested fluoride is absorbed. … Once absorbed into the blood, fluoride readily distributes throughout the body, with approximately 99 per cent of the body burden of fluoride retained in calcium rich areas such as bone and teeth (dentine and enamel) where it is incorporated into the crystal lattice. In infants about 80 to 90 per cent of the absorbed fluoride is retained but in adults this level falls to about 60 per cent. Fluoride is excreted primarily via urine (IPCS, 2002). Urinary fluoride clearance increases with urine pH due to a decrease in the concentration of HF. Numerous factors (e.g. diet and drugs) can affect urine pH and thus affect fluoride clearance and retention (USNRC, 1993)”

9. Pineal gland and bone elevated levels…girls had menarche 5 months earlier in high fluoride areas. Research on elderly remains had no information regarding health of the deceased. In another study of mouse brains drinking high fluoride water content who had behavioral abnormalities, the “control” mouse brains also had fluoride but did not show the behavioral abnormalities (internet interview source was lost unfortunately.)

10. Fertilizer source is not what you might think…Fluoride is a byproduct from crushed rock from which phosphorus is obtained for plant fertilization, not from the smelly other stuff from animal waste.

11. Industrial waste is misleading, fluoride comes from industrial economical use of the raw rock used in the phosphorus fertilizer industry.

12. Copper and lead corrosion. Salina water has very low copper and lead content plus alkalinity level and silicates that help protect copper pipes from corrosion. However, if you have an older home with copper pipes and lead fittings you may want to have your tap water tested.

13. Use and interpretation of research studies. Many of the animal studies I reviewed used extremely high doses of fluoride compared to the low level in treated public water systems. I consider that to be animal cruelty, unscientific, and misleading.The EPA report cited in The Salina Journal article “These are 6 powerful words” on October 23, 2014, reported studies with fluoride doses as high as 5 grams/kg (2.2 pounds) if the dose would not kill the animal. The pdf on neurotoxicity of aluminum and fluoride enhancement of the bioavailability could not be found. Page 30 of the open book citation is not related to the paragraph in the article. The open book article does give information on the difficulty of diagnosing fluorosis and much lower estimates of occurrence than the Salina Journal article. The incidence given in the article as cited in http://www2.aap.org/oral-health/pact/ch6_sect4b.cfm could not be found on Oct.23, 2014. However, according to http://pediatrics.aappublications.org/content/134/3/626.full?sid=2c29e725-dc1e-48ad-a4e3-14fd7fb0df28 the incidence in teens has increased 41% and not an overall incidence of 41% in teens.

14. Severity of Tooth Decay “ …tooth decay remains the most common chronic disease of children aged 6 to 11 years (25%), and of adolescents aged 12 to 19 years (59%)…

Know some of the factors that can increase your child’s risk for tooth decay. These include the following:

Older brothers, sisters, or parents who have had decayed teeth.

Taking in a lot of sugary foods and drinks, like soda, especially between meals.

Not brushing teeth daily.

Not using a fluoride toothpaste if older than age 2.

Your usual source of drinking water has a very low fluoride content.

Presence of special health care needs.

No family dentist or regular source of dental care.

Presence of braces or orthodontic or oral appliances.

excerpt and more at http://www.cdc.gov/fluoridation/factsheets/fl_caries.htm

15. Cost, Fluoride public water at the recommended level is the most economical way to help prevent dental cavities pain and tooth fillings in children and youth and helps prevent hip fractures in the elderly. Dental fluorosis costs can be prevented by following CDC recommendations for infants and children that reduces their total fluoride consumption. Reducing the amount of sweets eaten also helps reduce cost and pain related to decay. According to http://pediatrics.aappublications.org/content/134/3/626.full?sid=2c29e725-dc1e-48ad-a4e3-14fd7fb0df28 “Community water fluoridation is a safe, efficient, and cost-effective way to prevent tooth decay and has been shown to reduce tooth decay by 29%.35 It prevents tooth decay through the provision of low levels of fluoride exposure to the teeth over time and provides both topical and systemic exposure. It is estimated that every dollar invested in water fluoridation saves $38 (probably more at today’s prices) in dental treatment costs (http://www.cdc.gov/fluoridation/benefits/).”

16. Recommendations to prevent tooth decay and/or dental fluorosis. Babies formula should not always be made with fluoridated water since they drink so much in relation to body size. Breast feeding for the first 6 months is advised. Toddlers should not use fluoridated tooth paste for the same reason. Children up to age 6 should use only a pea sized gob of fluoridated tooth paste and encouraged not to swallow it. These measures help reduce the incidence of little white spots, fluorosis in their teeth and bones. Brown discoloration is from high levels of fluoride, from fever or other conditions.

From http://www.cdc.gov/fluoridation/safety/infant_formula.htmRecent evidence suggests that mixing powdered or liquid infant formula concentrate with fluoridated water on a regular basis may increase the chance of a child developing the faint, white markings of very mild or mild enamel fluorosis.

You can use fluoridated water for preparing infant formula. However, if your child is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance for mild dental fluorosis. To lessen this chance, parents can use low-fluoride bottled water some of the time to mix infant formula; these bottled waters are labeled as de-ionized, purified, demineralized, or distilled.”

From http://www.cdc.gov/fluoridation/faqs/dental_fluorosis/ “For very young children, less than 2 years old:Do not use fluoride toothpaste unless advised to do so by your doctor or dentist. You should clean your child’s teeth as soon as the first tooth appears by brushing without toothpaste with a small, soft-bristled toothbrush and plain water.

For children aged 2 to 6 years, apply no more than a pea-sized amount of fluoride toothpaste to the brush and supervise their toothbrushing, encouraging the child to spit out the toothpaste rather than swallow it. Until about age 6, children have poor control of their swallowing reflex and frequently swallow most of the toothpaste placed on their brush.”

and if your children are under 8 years old and local water has more than 2mg/L

Use an alternative source of water for children aged 8 years and younger if your primary drinking water contains greater than 2 mg/L of fluoride

In some regions of the United States, public water systems and private wells contain a natural fluoride concentration of more than 2 mg/L, and at this concentration, children 8 years and younger have a greater chance for developing dental fluorosis, including the moderate and severe forms. These children should have an alternative source of drinking water that contains fluoride at the recommended level.”

Additional Sources accessed October 22 and 23, 2014

City of Salina Water Reports for 2012 and 2013

http://www.who.int/water_sanitation_health/dwq/chemicals/fluoride.pdf

http://www.cdc.gov/fluoridation/safety/infant_formula.htm

http://www.cdc.gov/h1n1flu/infantfeeding.htm

http://www.ncbi.nlm.nih.gov/pubmed/18832828 recommends fluoride supplements in last 6 months of pregnancy.

http://www.ncbi.nlm.nih.gov/pubmed/18832828 Fluoride content in baby teeth

http://neurologyofkansas.com/your-health/?/21693/Iodine

http://ehp.niehs.nih.gov/wp-content/uploads/2012/09/ehp.1104912.pdf fluoride in China

http://www.emsworld.com/article/10915304/the-dangers-of-giving-too-much-oxygen

http://www.ncbi.nlm.nih.gov/pubmed/10675073 (hip fractures)

http://jn.nutrition.org/content/135/9/2247 high fluoride not related to bone fractures in women.

http://www.news-medical.net/news/20111223/Fluoride-has-dramatic-effects-on-bacteria-inside-the-mouth.aspx

http://consumerreports.org/cro/magazine/2012/11/arsenic-in-your-food/index.htm

http://ntp.niehs.nih.gov/ntp/htdocs/chem_background/exsumpdf/fluorosilicates_508.pdf

(Toxicological Summary for Sodium Hexafluorosilicate [16893-85-9] and Fluorosilicic Acid [16961-83-4])

http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf

2006 World Health Report

http://www.redicecreations.com/specialreports/fluoridepinealgland.html

http://www.sonomacountygazette.com/cms/pages/sonoma-county-news-article-2231.html both the article and the comments.

http://waterloowatch.com/Index_files/Coplan%20et%20al%202007%20Confirmation%20Of%20And%20Explanations%20For%20Elevated%20Blood%20Lead%20And%20Other%20Disorders%20In%20Children%20Exposed%20To%20Water%20Disinfection%20And%20Fluoridation.PDF

http://www.sciencedirect.com/science/article/pii/089203629400070T example of high dose water fluoride in rats study.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626340/ regarding need and cost

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626340/pdf/16211158.pdf

http://www.epa.gov/ncct/toxcast/files/summit/48P%20Mundy%20TDAS.pdf

not found http://www.fda.gov/ohrms/dockets/dockets/07p007/07p-007-cp00001-02-vol1.pdf

http://www.nap.edu/openbook.php?record_id=2204&page=11

http://www.nap.edu/openbook.php?record_id=2204&page=132 15-25% F not absorbed

http://pediatrics.aappublications.org/content/134/3/626.full?sid=2c29e725-dc1e-48ad-a4e3-14fd7fb0df28

Author Evelyn Maxwell, M.N., R.N. has a Bachelor’s Degree in Nursing Science from the University of Kansas School of Medicine 1955, Master’s Degree in Mental Health Nursing from University of Kansas Graduate School 1984, provides Whole Health Education and was a member of the Salina, Kansas, City Commission 1993-1997, Salina Mayor 1996-97.

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