Dear Mark: Is Fluoride Safe?
Today’s question addresses a contentious topic in the health arena: fluoride. It’s in (most of) the tap water we use, (most of) the toothpastes with which we brush, and even (all of) the teas we drink. It represents a bloody stage upon which skeptics and the natural health folks battle it out. Many in the Primal community would like to avoid it (as they would any government-endorsed hydroadditive) if possible; if it’s not possible, they at least want to know just how bad the stuff really is and whether its intake can be mitigated. Should we use fluoride-free toothpaste? Should we install household filters? Argh. So many questions and so few definitive answers… and here’s yet another. Ah, life!
Dear Mark,
What’s your take on fluoride? To drink fluoridated water, or to filter it? To use fluoride-free, natural toothpaste, or is it one of the benefits of living in a modern world?
I can’t seem to find any conclusive evidence on the web as to whether it is good or bad, and while I asked my dentist, I would love a second opinion. (his waiting room was full of posters advocating a “low meat, low fat diet”…)
Thanks,
Annika
I’m probably going to take flak for this one, but so be it. I’m not particularly concerned with fluoride in the water. While I’d definitely prefer it weren’t added to almost every municipal water supply in the country, I think we have far bigger fish to fry when it comes to health. Avoiding blatantly poisonous foods like grains, sugar, and industrial seed oils is the most important thing we can do, followed by getting adequate amounts of exercise, sleep, and sun while reducing or mitigating stress. Once you’ve got the chest freezer full of pastured animals, a good workout regimen dialed in, a source of pastured eggs you can rely on, the perfect sleeping position entrained, and you’re waking up without an alarm clock totally refreshed and energized, then you can think about installing an expensive reverse-osmosis filter for your entire house or importing Nepalese glacier water. Before that, I don’t think it’s worth the trouble.
But don’t take my word for it. Let’s look at the evidence. I’m going to focus on a recent report on current EPA standards regarding fluoride by the National Research Council’s Board on Environmental Studies and Toxicology. Before you assume that these groups, being governmental bodies, are automatically suspect, note that the EPA requested the report and, in response to the NRC’s findings, has recently recommended a reduction in the maximum allowed dose of fluoride to be present in drinking water. They also suggest an optimum dose to be added – 0.7 mg/L – down from the previous 0.7-1.2 mg/L range. Currently, the average fluoride content of fluoridated municipal water supplies is 0.8 mg/L.
There is strong evidence that fluoride does offer protection against dental caries, but “the more the better” is probably not true and most recent reviews of the evidence suggest that topical fluoride (as in toothpastes, gels, and foams) are more effective than systemic fluoride. The NRC report references several literature reviews that conclude “the major anticaries benefit of fluoride is topical and not systemic,” and a more recent study finds that evidence for topical fluoridation is far stronger than for municipal water fluoridation (PDF). In fact, fluoride is most effective in the “post-eruptive” period, or after teeth have begun to appear, rather than as a preventive measure. As for systemic fluoridation? 0.7 mg/L of drinking water seems to be the sweet spot where cavity protection peaks. In fact, some studies show that as fluoride concentration approaches 1.2 mg/L, cavity incidence increases (PDF), right in line with the NRC’s recommendations and just under the average dosage in most water supplies.
Fluoride appears to become really problematic to humans in two scenarios: when intake is extremely high; and/or when intake of other important micronutrients and minerals is low and inadequate. The primary health issues ascribed to fluoride consumption are bone health and thyroid dysfunction, for which there is ample evidence – but that doesn’t mean the amounts we typically get from fluoridated water are sufficient to provoke them. As per usual, the dose makes the poison.
Opponents of fluoridation claim that fluoride makes for brittle bones, low bone density, and higher fracture rates. Proponents claim the opposite. The truth appears to be someplace in between. One study looked at different populations in China with different levels of naturally-occurring fluoride in the water ranging from 0.25 mg/L to 7.97 mg/L. Fracture rates increased at both extremes, with the lowest rates coming in populations with water fluoridation at 1 mg/L and the highest rates coming at between 4 mg/L and 7.97 mg/L. So, ultra low levels weren’t protective, l0w-to-mid levels were, while mid-to-high levels were definitely not.
It seems that, unsurprisingly, how fluoride affects bone mineral density depends on factors beyond just the amount of fluoride you’re getting. Calcium matters, for one. Rats on a calcium-deficient diet displayed impaired bone density and strength when given fluoride at 10 ppm and 45 ppm, while it took fluoride at 45 ppm to induce bone density problems in rats with sufficient calcium. Note that it only took sufficient calcium rather than supranormal amounts of it to protect bone density. Vitamin D matters, too; researchers induced rickets in vitamin D deficient rats by giving mega doses of fluoride (between 30 mg/L and 100 mg/L, unheard of doses that you’d never encounter in real life). Giving vitamin D prevented rickets, even though intestinal absorption of fluoride was increased with vitamin D supplementation. And it looks like magnesium interacts with fluoride, too. Magnesium deficient rats have more fluoride in their bones and teeth, and a magnesium deficiency increases fluoride absorption rates.
Iodine status of the organism interacts with, and sometimes predicts, how fluoride will affect the organism. For example, rats with sufficient iodine intake are able to tolerate drinking water with a fluoride content of 10 mg/L without negatively affecting thyroid status. At 30 mg/L, those same rats display reduced thyroid function and increased thyroid weight. If rats are iodine deficient, however, 10 mg/L of fluoride is enough to severely hamper thyroid function. Iodine deficient cows are also more vulnerable to fluoride’s effects on the thyroid.
Since we can’t give megadoses of fluoride to iodine-deficient humans in RCTs, human studies are mostly epidemiological, and thus not conclusive. That doesn’t make them any less interesting, though. Workers in an aluminum processing plant showed signs of fluorosis and thyroid dysfunction; fluoride is a common byproduct of aluminum plants, so aluminum workers are exposed to an inordinate amount of fluoride on a daily basis. 65% of workers with more than ten years of service at the plant and 54% of workers with stage 2 fluorosis had hypothyroidism, while 76% of the workers diagnosed with chronic fluoride intoxication (indicated by liver damage) also had hypothyroidism. In other words, the greater their exposure to fluoride, the greater their chances of developing hypothyroidism. The average intake for workers was 10 mg of fluoride per day. For comparison’s sake, most fluoridated tap water contains around 1 mg/L fluoride, so you’d have to drink 10 liters of tap water just to approach the amounts these workers were taking in. Another study actually tried to use fluoride as a treatment for hyperthyroidism. Out of fifteen patients with clinical hyperthyroidism, six responded well to fluoride treatment, with basal metabolic rate lowering to normal levels and the symptoms of hyperthyroidism abating. Although fluoride treatment was considered statistically ineffective in the other nine patients (most of whom had Grave’s disease, an autoimmune hyperthyroid disorder that isn’t really linked to iodine intake), some displayed modest signs of improvement nonetheless.
Overall, iodine status seems to determine whether fluoride will negatively affect the thyroid. Excessive amounts of fluoride exert negative effects regardless of iodine status, but standard fluoridation should be pretty harmless to the thyroid as long you get enough iodine.
They also looked at data on fluoride and various cancers, cognitive deficits, reproductive dysfunctions, liver/kidney/immune systems, but found nothing conclusive. Acutely elevated intakes beyond what you’d get from 4 mg/L exposure was linked with liver and kidney damage, but no evidence that normal intakes are dangerous. They also note that folks with renal impairments tend to accumulate and absorb more fluoride than people without kidney problems (since excess fluoride usually passes through the kidneys en route to the toilet). I recommend reading the linked sections, as they go over all the evidence and explain why it might mean something or why it might not. I’m not totally convinced we have nothing to worry about. There’s a lot to wade through, including some interesting cancer epidemiology.
What about other sources of fluoride? Fluoride isn’t just in the water we drink. It’s also in the products that use tap water, like soda and beer. It’s in tea leaves, with black having the highest levels and white having the lowest. Although one woman even developed severe skeletal fluorosis from drinking two gallons of tea each day for thirty years, tea consumption has reams of epidemiological and clinical evidence for its benefits that can’t be thrown out simply because of the fluoride content. Moderation is key, and longer brewing times increase fluoride release. It’s also commonly found in toothpaste. A pea-sized dollop of fluoride toothpaste has about 0.3 mg fluoride, while a larger, commercial-esque serving contains upwards of 2.25 mg. Don’t swallow your toothpaste (whether you use fluoride-free or not) and you’ll be okay.
Bottom line? Fluoride is a ubiquitous trace element that you can’t completely avoid, so to lose sleep over it is probably counterproductive. To wage campaigns against it and spend your days raging about it probably cause more stress and harm than they help. It’s in the food, in the soil, in tea leaves, in the water, and in any product that uses or includes municipal water. The best advice is first to avoid processed food, which you already do (right?). Next, eat lots of plants and animals to insure mineral repletion (while avoiding grains and legumes rich in mineral-binding phytic acid). Then, get daily sun or take a vitamin D supplement. Last, eating good Primal food means you’re avoiding the processed junk and sugary drinks that are high in fluoride. After that, I think you’re good. If you’re anything like me, you’re probably getting most of your hydration through real food, rather than gallon jugs of bottled water – so there’s another avenue of avoidance. To be on the safe side, check the local levels of fluoride (some naturally occurring water sources have levels far higher than the 0.7 mg/L-1.2 mg/L they add to water, so even non-fluoridated areas could be getting really high levels, which you do want to avoid) and respond accordingly. A reverse-osmosis filter, while expensive and somewhat wasteful, will remove fluoride.
It may be that I’ve been sheltered from water fluoridation – Malibu only recently got fluoride added to the water supply – but I haven’t noticed any ill effects, and I drink both tap and tea. High levels are harmful, but they aren’t common. One estimate pegs average daily intake of fluoride for a teenager living in a fluoridated area at around 1.85 mg. For non-fluoridated teens, it’s 0.86 mg/day. For people living and eating Primally? I’d wager it’s even lower and safer than that. You gotta look at the big picture. Complete avoidance of fluoride in all forms is impossible (and unnatural – remember, fluoride occurs naturally in water), so just make sure you’re good in all other aspects of health and let the chips fall where they will.
Did I miss anything? Are normal physiological doses of fluoride as dangerous as some people say? Is it all worth stressing over? I’m totally open to being enlightened. Let’s get it going in the comments (and I know you guys got plenty of ‘em!).
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Posted By: Mark Sisson
Have you really researched the dangers of fluoride?Look what is happening to the people in India on natural occuring fluoride.They are being crippled and blinded by natural Fluoride.Do you know that fluorides leech lead/arsenic etc.etc.etc?Did you know about the calcification of the pineal gland on Fluorides?
I’d like to add that since I’ve gone to a flouride free toothpaste, I’ve noticed that I’ve had fewer occurances of the makings of a sore throat. I’m sure the change in diet has helped, but it’s been nice to not wake up in the morning with that.
The short answer is yes, water fluoridation is bad. The problem is, people refer to “flouride” improperly in conversation, which has led to much confusion to this day. “Naturally occurring” floride is Calcium Flouride. Whatever remote dental beneficial effects ever recorded are actually due to the calcium in that compound, not the fluoride (just like when you drink milk for the calcium, go figure). “Flouride” is just some compound of flourine (NOT flourene). So saying “flouride” by itself is nonsensical, since one should include the element(s) it’s bonded. Oh, and flourine is toxic and not found naturally by itself unless created by a star or in a lab using a lot of energy (the early scientist that figured this out got sick or died playing around with it… hmmm, must be good then for your health right?) . Fluoridation, or adding flouride to water, is not adding calcium flouride. It’s adding one of 3 types of fluoride compounds, all resulting as some byproduct of some industrial process as a waste (sodium flouride for example). Incidentally, these also had other uses such as rat posion, which is way the early efforts to convince people that sodium-flouride was a helpful water additive ran into a lot of trouble. If it’s poison for rats, how is it safe for humans just because it’s in water? Hmmm…
Don’t trust your dentist. It’s outside their professional preview to assess the toxic effects of ingested flouride compounds in water. They only can give their professional opinion about what it does in your mouth. Period. Besides, dentists must march to the tune of the ADA (American Dental Association), and if they say it’s safe, then that’s what they tell you. Use the web to your advantage and read! Also, any benefits to fluoride are topical only, not systemic from ingestion. Again, why must our water by fluoridated then if it’s only topically beneficial? (even a resent CDC study points this out, but still recommends putting it in water as its conclusion). The ADA’s offical stance is that yes fluoridation causes dental flourisis (yellow staining), but that is a cosmetic concern, not a health one. So do you really trust your doctor as the best judge of it effecting your health? Flouride toothpaste has up to 1000 ppm (yes, 250 times the toxic limit to humans). Kids have died from accidently swallowing fluoride toothpaste or mouth rinse at dental offices.
Water consumption doesn’t consider all the other sources of water with flouride we’re exposed to. Our skin absorbs water. How often do you take a shower, bath, wash your hands? Foods and plants that we eat are have absorbed water and thus flouride in nature. Processed foods may have been made with fluoridated water if it’s in their city water. All this isn’t reflected in the EPA’s recommended safe range of 0.7-1.3 ppm. But it’s known than 4 ppm’s is the toxic level for humans, and 1-3 ppms causes problems and onset of heath issues by itself. Do you think you’re at a safe level then just because the drinking water is .7-1.3? A lot of people probably have fluoride poisoning and don’t know it (check you teeth for white flecks).
I didn’t include any sources for any of this because it’s all on the web folks, (and it’s off the top of my head from what I’ve read, so it may be slightly inaccurate, but not by much!). Do some research, read back to the original reports and erroneous ones from the FDA, EPA and CDC that stemmed from Alcoa’s early 1900′s efforts to figure out how to rid itself of it’s toxic sodium-fluoride industrial waste by “storing” it in humans through fluoridated water consumption, marketed on fabricated science. It’s a huge crime. How do you feel being a toxic waste site with two legs? It’s linked to a lot of health concerns that even doctors aren’t aware of or won’t admit.
The MDA link to all this is that, no, you don’t need flouride if you eat primal, because you won’t have all the sugar acting on your teeth to have dental concerns if you just brush regularly with non-flouride toothpaste (baking soda for example). You just need something to act as an abrasive to help remove stuff on your teeth, that’s all flouride in toothpaste is doing for you. Live without it.
What do you guys have to say about this article from Weston Price?
http://www.westonaprice.org/environmental-toxins/fluoride-worse-than-we-thought
The article suggests that even smaller doses of fluoride from drinking water (0.1mg/L) could cause dental fluorosis. This article has alleviated most of my concerns, but I would still like some feedback.
This is a GREAT video by Dr. Paul Connet; it def. explains the issue much more in detail. what do you guys think?
http://www.youtube.com/watch?v=zo6SnvmMP9k&feature=player_embedded#!
For those who don’t know the difference between fluorINE and fluorIDE. It’s one electron and like everything else in elemental chemistry it completely alters the activity and reactivity of the atom.
fluorINE can be stable in some configuations but when it’s hit with some ionising radiation like a UV ray the electron/s can be lost and then it turns into the extremely reactive, fluorine free radical which is so unstable & reactive it will steal an electron from anywhere it can to become the very stable fluorIDE ion.
Where it takes the electron from is now electron deficient and will try to steal one from somewhere else… oxidative damage chain started. Stable in a test tube perhaps but not in the real world.
I see that many have tried to explain the science of fluoride (which I believe only 1 person got the chemistry correct), and many that mention studies that “prove” fluoride is harmful to our our health, but I wonder how many have actually read the studies rather than just believing a headline they read. Many comments are just repeating what has been read on anti-fluoride websites, which rarely do those sites provide any source citations for the claims they make. I made it my mission recently to fully investigate all issues regarding fluoride because, frankly, those of us in the dental field really don’t cover much on the issue during our education. I would encourage anyone wanting the FULL story on fluoride to read my article. I cover the science, the history, the controversy, the studies…everything!I’d love to hear what you think!
http://thepaleohygienist.com/2012/08/30/fluoride-facts-controversy-science/
Debbie, I wonder why you still believe the people in power have your best interest at heart and really want you to be healthy and live long. They want that, of course, but with all the dependencies on their pharmaceutical industry. The problem with you people is that you try to go out of your way just to prove your masters are kind. You don’t want to be free, you just want to be a good slave and serve them well so they don’t whip you and maybe throw some leftovers to your deluded self. It’s not only about flouride, it’s about everything else combined that you can’t see. You use their studies to prove their point. You can’t think for yourself for you have been robbed of thinking, you only react to what they tell you. You don’t see anything wrong in this society, don’t you? Bury yourself in your fiction, for things are about to get “better” for you.
Unless this world turns to Jesus Christ, who is the Truth and will bring knowledge and wisdom when obeyed, you are all going to be “destroyed for lack of knowledge” (Hosea 4:6) for you are cursed: “Cursed be the man that trusteth in man, and maketh flesh his arm, and whose heart departeth from the LORD.” – Jeremiah 17:5 (it means that you trust man’s stupid false science rather than God). Search the word pharmakeia, it was in the Holy Bible long before the world devised the word pharmacy out of it (but it’s just a coincidence for you, this whole word is a coincidental utopia).
How many of you have the character, strength and courage to acknowledge you were WRONG?
I want this POISON out of my freaking water!! Is that too much to ask? Seriously.
I recently went on a tour of the Louisville, KY Water Company’s facility and saw how the import and treatment process happens.
I had a chance to ask about fluoride and was pretty shocked at how silly the process was explained.
Basically, you should take river water, filter it, purify it and then distribute it.
But, right before the water goes out to be available for people’s tap, they bring in TRUCKLOADS of fluoride to add to the water.
The lady expressed a weird mood towards the whole situation and couldn’t give me any more details on the process behind adding sodium fluoride to the water beyond that.
Also, it’s required by law to add fluoride to the water supply here. Just another brick in the wall some conspirators could say.
I’m indifferent. Take care everyone.