Fluoride 101 Everything You Need To Know 5-31-08

by Donald W. Miller, Jr., MD
by Donald W. Miller, Jr., MD

The federal government’s Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA) are holding a symposium in Chicago this week titled: "National Fluoridation Symposium 2005: Celebrating 60 Years of Water Fluoridation" (July 13–16). The CDC ranks fluoridation of community drinking water as one of the ten most significant public health achievements of the 20^th century.

No speaker at this symposium will dare question the safety or efficacy of fluoride. That is now a given and has become dogma. But like in 1968 when protests against the Vietnam War were held in the Windy City outside the Democratic National Convention, this week protesters have assembled in Chicago to fight fluoridation.

Fluoridation of community drinking water began in Grand Rapids, Michigan on January 12, 1945. It was the brainchild of two people who worked for Andrew W. Mellon, founder of the Aluminum Company of America (ALCOA), Drs. H. Trendley Dean and Gerald J. Cox. Mellon was US Treasury Secretary, which made him (at that time, in 1930) head of the Public Health Service (PHS). He had Dean, a researcher at the PHS, study the effects of naturally fluoridated water on teeth. Dean confirmed that fluoride causes mottling (discoloration) of teeth, and he hypothesized that it also prevents cavities. Cox, a researcher at the Mellon Institute in Pittsburgh, was urged to study the effect of fluoride on tooth-decay in rats. Determining that it had a beneficial effect, he proposed, in late 1939, that the US should fluoridate its public water supply.

Fluorine is a halogen, like chlorine and iodine. It is the smallest and most reactive element in the halogen family (elements with 7 electrons in their outer shell). Fluorine exists in nature attached to other elements as the negatively charged ion fluoride, most notably to hydrogen, calcium, sodium, aluminum, sulfur, and silicon. Sodium fluoride, a by-product of aluminum smelting, initially was used to fluoridate water. Silicofluorides (fluoride combined with silicon), wastes of phosphate fertilizer production, are now used almost exclusively for fluoridation. Fluorine is also present in compounds called organofluorines, where fluorine atoms (not fluoride anions) are tightly bound to carbon. Teflon (poly-tetra-fluoro-ethylene), Gore-Tex, and many drugs, Prozac (fluoxetine), Cipro (ciprofloxacin), and Baycol (cerivastatin) among them, are organofluorines.

Doctors and public health officials did not think sodium fluoride, used commercially as a rat and bug poison, fungicide, and wood preservative, should be put in public water. The Journal of the American Dental Association said (in 1936), "Fluoride at the 1 ppm [part per million] concentration is as toxic as arsenic and lead… There is an increasing volume of evidence of the injurious effects of fluorine, especially the chronic intoxication resulting from the ingestion of minute amounts of fluorine over long periods of time." And the Journal of the American Medical Association" noted (in its September 18, 1943 issue), "Fluorides are general protoplasmic poisons, changing the permeability of the cell membrane by certain enzymes." But, as Joel Griffiths and Chris Bryson reveal in "Fluoride, Teeth, and the Atomic Bomb," and Bryson in his book The Fluoride Deception, officials in the Manhattan Project persuaded health policy makers and medical and dental leaders, in the interests of national security, to do an about-face and join the fluoridation bandwagon.

Vast amounts of fluoride were required to build the atom bomb. Fluoride combines with uranium to form the gas uranium hexafluoride, which, when passed through a semi permeable membrane, separates bomb-grade, fissionable uranium-235 from the much more abundant and stable uranium-238. This done, fluoride is released into the environment as waste. (During the Cold War millions of tons of fluoride were used in the manufacture of bomb-grade uranium and plutonium for nuclear weapons.) Also, large amounts of fluoride were generated in producing aluminum required for warplanes.

With several instances already on record of fluoride causing damage to crops, livestock, and people downwind from industrial plants, government and industry, lead by officials running the Manhattan Project, sought to put a new, friendlier face on fluoride. This would dampen public concerns over fluoride emissions and help forestall potentially crippling litigation. Instead of being seen as the poison it is, people should view fluoride as a nutrient, which gives smiling children shiny teeth, as epitomized in the jingle that calls fluoride "nature’s way to prevent tooth decay."

It worked. Early epidemiological studies showed a 50 to 70 percent reduction in dental cavities in children who drank fluoridated water. These studies, however, were poorly designed. None were blinded, so dentists examining children for caries would know which kind of water they were drinking. Data gathering methods were shoddy. By today’s evidence-based medicine standards these studies do not provide reliable evidence that fluoride does indeed prevent cavities.

Based on these studies and its promotion, municipalities across the country started adding fluoride to their water supply. Within 15 years a majority of Americans were washing their clothes, watering their vegetable gardens, bathing with, and drinking fluoridated water.

On its 60^th anniversary proponents still have not proved that the hypothesis fluoride [put in public water] prevents cavities and is perfectly safe is true. The first part of the hypothesis, at least, has biological plausibility. Fluoride prevents cavities by combining with calcium in dental enamel to form fluoroapetite, which increases the resistance of teeth to acid demineralization. And fluoride inactivates bacteria that damage teeth by interfering with their enzymes. But biological plausibility alone is not sufficient to prove efficacy. Epidemiological evidence is required to do that. A debate open to well-informed opponents of fluoridation, if the CDC and ADA ever agreed to hold one, would show that existing epidemiological evidence does not prove that fluoride prevents cavities.

In evidence-based medicine, systematic reviews (meta-analyses) are considered to be the best, most "scientific" evidence. A systematic review of water fluoridation studies, published in the British Medical Journal in 2000, found, as the chair of the Advisory Group that commissioned the review puts it, "The review did not show water fluoridation to be safe. The quality of the research was too poor to establish with confidence whether or not there are potentially important adverse effects in addition to the high levels of [dental] fluorosis." He adds, "The review team was surprised that in spite of the large number of studies carried out over several decades there is a dearth of reliable evidence with which to inform policy." The case for fluoride does not stand up to careful evidence-based scrutiny.

Evidence that "fluoride [put in public water] does not prevent cavities and is not safe" (the null hypothesis) is more convincing. If a court of law held a trial on fluoride’s safety and efficacy, the anti-fluoridationists would win. The judgment in their favor would most likely be beyond a reasonable doubt, or at least on a more likely than not basis. In a courtroom the pro-fluoridationists would not be permitted to employ ad hominem attacks that focus on the character of the opposing witness instead of the evidence, and dogmatic assertions on the safety and efficacy of fluoride would be subject to cross examination.

Proponents of fluoridation will not willingly admit they are wrong. As Tolstoy puts it, "Most men can seldom accept even the simplest and most obvious truth if it would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, have proudly taught to others, and have woven thread by thread into the fabric of their lives."

There are exceptions. Two prominent leaders of the pro-fluoridation movement willingly admitted publicly (in 1997 and 2000) that they were wrong. One was the late John Colquhoun, DDS, Principal Dental Officer for Auckland, New Zealand and chair of that country’s Fluoridation Promotion Committee. He reviewed New Zealand’s dental statistics in an effort to convince skeptics that fluoridation was beneficial and found that tooth decay rates were the same in fluoridated and nonfluoridated places, which prompted him to re-examine the classic fluoridation studies. He recanted his support for it in "Why I Changed my Mind About Water Fluoridation" (Perspectives in Biology and Medicine 1997;41:29–44). The other is Dr. Hardy Limeback, PhD, DDS, Head of Preventive Dentistry at University of Toronto. His reasons are given in "Why I am Now Officially Opposed to Adding Fluoride to Drinking Water." Another former pro-fluoridationist that is fighting fluoride in Canada, and elsewhere, is Richard G. Foulkes, MD, a health care administrator and former assistant professor in the Department of Health Care and Epidemiology at the University of British Columbia.

Chlorine is added to water to kill bacteria. Chlorination (begun in 1908) has eradicated typhoid fever and cholera, two water-borne diseases that used to kill thousands of Americans each year. Chlorine is a disinfectant. Fluoride is a medication, which the state requires all people to consume because government officials believe it is good for a segment of the population. The putative benefit of this medication is for children age 5 to 12 (when enamel for their permanent teeth is being formed). This age group drinks 0.01 percent of the water people use.

This is how the CDC justifies compulsory fluoridation: "Although other fluoride-containing products are available [e.g., toothpaste], water fluoridation remains the more equitable and cost-effective method of delivering fluoride to all members of most communities, regardless of age, educational attainment, or income level." Fluoridation, therefore, addresses social inequalities and fosters social justice. It provides fluoride to poor families without their having to buy (fluoride) toothpaste and make their children brush their teeth with it. The common good takes priority over individual freedom to choose to not take this medication. This communitarian ethic increasingly governs US public health policy. One of the goals of the government’s Healthy People 2010 initiative (Objective 21-9) is to "increase the proportion of the U.S. population served by community water systems with optimally fluoridated water [the target: 75 percent]."

Murray Rothbard (in an article written in 1992) describes water fluoridation as "ALCOA-socialism," arising from "an alliance of three major forces: ideological social democrats, ambitious technocratic bureaucrats, and Big Businessmen seeking privileges from the state." It is a legacy of war, with its call for aluminum and enriched uranium, and the New Deal.

Fluoridation is an especially destructive type of socialism because fluoride is a poison. It is the 13^th most common element and one of the most toxic elements in the earth’s crust. It is an insidious poison that produces serious multisystem effects on a long-term basis.

Fluoride disrupts enzymes (by altering their hydrogen bonds) and prevents them from doing their job of making proteins, collagen in particular, the structural protein for bone and teeth, ligaments, tendons, and muscles. It damages DNA repair enzymes and inhibits the enzyme acetylcholinesterase in the brain, which is involved in transmitting signals along nerve cells. All cells in the body depend on enzymes. Consequently, fluoride can have widespread deleterious effects in multiple organ systems. One researcher has uncovered 113 ailments that fluoride is said to cause.

The first visible sign of fluoride poisoning is dental fluorosis. It begins as small white specks in the enamel that then turn into spots, become confluent, and, in its most severe stage, turn brown. Dental fluorosis of varying degree affects 20 to 80 percent of children who grow up drinking fluoridated water. Moderate to severe changes, with brown mottling, occurs in 3 percent of children. Dental fluorosis is an indicator of fluoride toxicity in other parts of the body. Like in growing teeth, fluoride accumulates in the brain. One manifestation of "brain fluorosis" in children could be this: Researchers (in China) have found that children living in an area where the water has high fluoride content (4.12 ppm) have IQ scores that are 6 to 12 points lower than children living in a low fluoride district (the difference in IQ scores, at p <0.02, is statistically significant).

Fluoride has a particular affinity for calcium and thus for bone; and it poisons bones the same way it does teeth. The average American living in a fluoridated community now ingests 8 mg of fluoride a day. Unlike teeth where the enamel, once formed, remains static, 10 percent of bone tissue is broken down and replaced annually, giving fluoride an opportunity to steadily accumulate year-after-year in bones. People who consume 10–25 mg of fluoride a day over 10 to 20 years, or 2mg/day over 40 years, will develop skeletal fluorosis. The first manifestations of this disease, before there are any changes on x-ray, are joint pains and arthritic symptoms, which are indistinguishable from osteoarthritis and rheumatoid arthritis; muscle weakness; chronic fatigue; and gastrointestinal disorders. In the next stage, osteoporosis develops and bones become more brittle and weak, making them prone to fracture. (The third and final stage, crippling fluorosis, occurs mainly in India where the natural fluoride content of the water is high.)

There is an epidemic of arthritis, osteoporosis, hip fractures, and chronic fatigue syndrome in the United States. Could fluoride be causing this epidemic? It turns out that even people who live in nonfluoridated areas consume a lot of fluoride, on average 4 mg/day. It is in toothpaste; in fruit juices, soda pop, tea, and processed foods; and, unfortunately, in California wines, whose grapes are sprayed with the pesticide cyrolite (sodium aluminum fluoride). American physicians know little or nothing about skeletal fluorosis, and the early, arthritic stages of this disease mimic other bone and joint diseases. It is a hypothesis worth testing.

Studies show that the rates of bone cancer are substantially higher in fluoridated areas, particularly in boys. Other cancers, of the head and neck, GI tract, pancreas, and lungs, have a 10 percent higher incidence. Fluoride affects the thyroid gland and causes hypothyroidism, which is also an increasingly frequent disorder in the US. Other studies show that high levels of fluoride in drinking water are associated with birth defects and early infant mortality.

Fluoride also damages the brain, both directly and indirectly. Rats given fluoridated water at a dose of 4 ppm develop symptoms resembling attention deficit-hyperactivity disorder. High concentrations of fluoride accumulate in the pineal gland, which produces serotonin and melatonin. Young girls who drink fluoridated water reach puberty six months earlier than those who drink unfluoridated water, which is thought to be a result of reduced melatonin production. People with Alzheimer’s disease have high levels of aluminum in their brains. Fluoride combines with aluminum in drinking water and takes it through the blood-brain barrier into the brain. Dr. Russell Blaylock, MD, a neurosurgeon, spells out in chilling detail the danger fluoride poses to one’s brain and health in general in his book Health and Nutrition Secrets that can Save Your Life (2002).

Try to avoid fluoride, in all its guises. It is not an element the body needs or requires, even in trace amounts. There are no known naturally occurring compounds of fluorine in the human body.

Live in a nonfluoridated community. If that is not possible, drink distilled water or tap water passed through a filter that can remove fluoride (a third method using an activated alumina absorbent is not practical because of its expense). Regular activated carbon filters do not work because the diameter of a fluoride anion (0.064 nm) is smaller than the pore size of the filter. It requires a reverse osmosis filter. (Living in a fluoridated area, my family uses a table top reverse osmosis filter that we purchased online.) Distilled water has been given a bad rap by some health writers, which is not deserved (see "Blowing the Lid off Distilled Water Myths"). Distillation units are relatively inexpensive.

Fluoride is readily absorbed through the skin (and inhaled). Two-thirds of the fluoride we take into our bodies using fluoridated public water comes from bathing and wearing clothes washed in it. Drinking fluoride-free water in a fluoridated district only reduces fluoride intake by about a third.

One of the greatest public health advances in the 21^st century will be removing fluoride from public water supplies. This "important public health measure" is a Potemkin Village – an impressive façade that hides undesirable facts. In this village, the US Surgeon General, the Czar, in this case, tells visiting dignitaries that "Community water fluoridation benefits everyone," and "There is no credible evidence that fluoridation is harmful." This has given fluoride a protected pollutant status for 60 years when the stark fact is that this substance is slowly poisoning us.

In addition to being contaminated with trace amounts of arsenic, beryllium, mercury, and lead, silicofluorides (hexafluorosilicic acid [H₂SiF₆] and its sodium salt hexafluorosilicate [Na₂SiF₆]) carry lead through the intestine into the body. These are the compounds that, untested, now are used to fluoridate water. Lead interferes with the neurotransmitter dopamine, which controls impulsive and violent behavior; and studies show that lead pollution is linked to higher rates of violent crime. The average violent crime rate in US counties that have lead pollution is 56 percent higher when their drinking water is fluoridated, as reported in "A Moratorium on Silicofluoride Usage will Save $$Millions (Fluoride 2005;38:1–5). School shootings occur ten times more frequently in fluoridated communities, as Jay Seavey points out in "Water Fluoridation and Crime in America (Fluoride 2005;38:11–22).

Antifluoridationists weaken their case by mistakenly putting florine-carbon organofluorines in the same category as fluoride anions, as Joel Kauffman, a chemist, points out. The fluorine in these compounds is not dangerous (Teflon heated continuously at 500° F does not release any fluoride.) Policy makers will be better able to deal with fluoridation of water alone and ban it when organic (carbon-based) fluorine compounds are removed from consideration.

The day will come when fluoridation of community drinking water will suffer the same fate as blood letting. Used for over a millennium to treat disease, it was abandoned three centuries ago.

Recommended Reading:

• "Water Fluoridation: a Review of Recent Research and Actions," by Joel M. Kauffman, PhD. Published last month in the peer-reviewed Journal of American Physicians and Surgeons, this well-considered, succinct, up-to-date review would be Exhibit A in a trial against fluoridation. The author brought to my attention the distinction between inorganic fluoride anion and organically carbon-bound fluorine. (J Am Phys Surg 2005;10:38–44.)
• "Fluoridation of Water," by Bette Hileman. Published in Chemical and Engineering News in 1988, this "Special Report" by an associate editor of the journal examines the fundamental issues and specifics of fluoridation, which scientists, policy makers, and the public must confront. It shows that the fluoride controversy is much more serious than most people at the time, including scientists, realized. This seminal article gives important examples of how data on fluoride’s adverse effects are withheld from the public. (August 1, 1988 C&EN, p. 26–42, with links to the article’s four sidebars and to 39 letters published in C&EN about it, including one from Surgeon General C. Everett Koop.)
• "Fluoride: Commie Plot or Capitalistic Ploy," by Joel Griffiths. Originally published in Covert Action Quarterly in 1992, this article, with a photo of Capt. Jack Ripper in Dr. Strangelove saying, "Have you ever seen a commie drink a glass of water?," is another classic on the subject.
• Fluoride: Drinking Ourselves to Death? by Barry Groves (2001) This thoroughly researched and well written book refutes, one by one, answers the British Fluoridation Society told UK dentists to give to (32) questions people might ask them about Fluoride – questions like "Is fluoridated water safe?" and "Is it true that there is enough fluoride in a tube of toothpaste to kill a small child?" (The BFS answer to the toothpaste one is: "Used sensibly, fluoride toothpaste presents no risks to children.")
• "50 Reasons to Oppose Fluoridation" by Paul Connett. There are, indeed, 50 reasons. Written by the Executive Director of the organization that held the protest in Chicago.
• The Fluoride Deception by Christopher Bryson (2004) A good review of this book can be found here. The author has thoroughly researched the subject and obtained previously unreleased documents on the wartime politics behind fluoridation. He pulls down its façade and lays bare this Potemkin Village.
• "A Bibliography of Scientific Literature on Fluoride." A good compilation of references, arranged by subject. It is 55 pages long.