Water Fluoridation by Paul Connett, PhD

The Latest Science Indicates That the Practice Must Stop

Water fluoridation is the deliberate addition of a substance containing, or yielding, fluoride (that is, in the form of the free fluoride ion) to the public water supply with the ostensible aim of reducing tooth decay. The concentrations of fluoride used for this purpose in the U.S. range from 0.7 to 1.2 milligrams of fluoride per liter of water (0.7-1.2 parts per million or ppm). When the practice began in the U.S. and Canada in 1945 there were no published studies available which demonstrated that consuming fluoride at these levels was safe.

Without any formal study, it was assumed that because some people in some places had consumed natural fluoride levels higher than 1 ppm for many years, with no “apparent” harm recorded, adding fluoride to water would be safe.

The authors both work for the Fluoride Action Network (FAN),¹ a nonprofit dedicated to education and sharing information on the toxicity of fluoride. FAN maintains the largest database dedicated to fluoride’s toxicity on blood,² bone,³ brain,⁴ heart,⁵ kidney,⁶ liver,⁷ lung,⁸ the reproductive system,⁹ and the thyroid gland;¹⁰ as well as the largest collection of news articles on fluoride¹¹ that are accessible by country, by state for the U.S. and by province for Canada. The website also contains links to many videotaped interviews,¹² government reports by country,¹³ fluoride industrial emissions by state¹⁴ and more.

NEITHER ETHICAL NOR SCIENTIFIC

It was neither ethical nor scientific to force people to consume fluoride in 1945, and it is not ethical or scientific to do it today. The arguments get stronger as U.S. authorities are finally getting around to doing the studies on tissues that they should have conducted many years ago—and should have done before they started what has amounted to one of the largest public health experiments in U.S. history.

PROTECTING A BELIEF SYSTEM

The dilemma for those who believe that this practice is causing harm is how to end it when most people don’t even know their water is being fluoridated and don’t know the potential risks it may be posing to their children. Sadly, most doctors and dentists simply follow the policies of their professional bodies without reading the literature for themselves. The media are not telling the public about the latest health studies and are simply parroting statements from organizations like the American Dental Association (ADA) and agencies like the Oral Health Division of the Centers for Disease Control and Prevention (CDC), which hold a long standing “belief” in the “safety and effectiveness” of this practice. Meanwhile, government health departments at all levels appear to be more interested in protecting this outdated policy than protecting the health of our children.

The task that FAN has set itself since 2000 is to share the science about the dangers posed by this practice with those who are willing to read and listen, mainly through our web page at FluorideALERT.org and through public presentations (for example, in Seattle¹⁵). The latest science makes it very clear that the practice of fluoridation must stop!

FLUORIDE AND INTELLIGENCE

In 2006, the National Research Council (NRC) of the National Academies concluded that “fluorides have the ability to interfere with functions of the brain”¹⁶ and for the first time called fluoride an endocrine disruptor.¹⁷

In 2006, there were only five IQ studies available to the NRC panel. Subsequently, many more have been published (including studies that were previously only available in Chinese). As of 2019, we now have sixty studies, fifty-three of which have shown a lowered IQ in children in communities with high fluoride exposure compared to communities with lower fluoride exposure.¹⁸

Most of these studies have been carried out in China, but others took place in India, Iran and Mexico. In 2012, twenty-seven of these studies were subjected to a meta-analysis by a team from Harvard, which was published in one of the world’s leading environmental health journals, Environmental Health Perspectives.¹⁹ While this team had concerns about the lack of information on several possible confounding factors in many of these studies, they were struck by the consistency of the results. Even though the research was carried out over a period of twenty-one years, by many different research teams, in two countries (China and Iran) and in many different locations, twenty-six out of the twenty-seven studies found the same result: a lowering of IQ. The average lowering was seven IQ points.

It should be noted that a shift downward of five IQ points in a large population would halve the number of very bright children (IQ greater than one hundred thirty) and increase by over 50 percent the number of mentally handicapped (IQ lower than seventy). Such a downward shift would have both huge economic and social consequences for a country like the USA.

Promoters of fluoridation have done their best to diminish the significance of these findings for fluoridated communities, but recent findings have largely undermined their self-serving arguments. A rigorous U.S. government-funded study carried out by a highly qualified research team headed by Dr. Morteza Bashash confirmed that fluoride is neurotoxic at levels currently experienced in fluoridated communities and, for this effect, the most vulnerable stage of human life is during fetal development.²⁰ This study was conducted in Mexico City with two hundred ninety-nine mother-offspring pairs. The authors found strong associations between fluoride exposure to the pregnant women (as measured in their urine) and lowered IQ in their offspring at age four and again at six to twelve years of age. Subsequently, in 2018, a study reported that the lowering of IQ in the same cohort also occurred in an earlier age range (one to three years).²¹

In 2018, using the same Mexico City cohort, Dr. Bashash found that there was a strong association between some of the symptoms of ADHD in the children and urine fluoride levels in the pregnant women.²² A 2015 study found a relationship between the prevalence of ADHD in the U.S. and fluoridation status by state; the higher the percentage of the state fluoridated, the greater the prevalence of ADHD.²³

It is hard to overstate the importance of the 2017 Bashash study.²⁰ Strikingly, it was funded by U.S. government agencies, two of which (National Institutes of Health and the Environmental Protection Agency) have promoted (NIH) and defended (EPA) the safety of water fluoridation. The study was part of a twenty-five-year ELEMENT research project (Early Life Exposures in Mexico to Environmental Toxicants) directed by professor Howard Hu from the University of Toronto. The Bashash study took over twelve years and involved researchers from many distinguished universities and institutions in Canada, the U.S. and Mexico. These included the universities of Toronto, McGill, Indiana, Illinois, Michigan, Harvard, as well as Mount Sinai and the National Institute of Perinatology in Mexico. These researchers have published over fifty studies conducted along similar lines for other neurotoxicants. Of particular importance was the fact that, unlike most of the other IQ studies on fluoride, this study involved measurements at the individual (not community) level for both mother and child. Based upon their extensive experience, the authors controlled for a large number of potential confounding variables, and even after controlling for these they still found a very strong relationship between fluoride exposure during pregnancy in the mother and lowered IQ in their offspring.

Fluoridation promoters, including the American Dental Association, have claimed that this study was not relevant to fluoridated communities in the U.S. because Mexico City does not have artificial fluoridation and pregnant women there are likely to have higher doses of fluoride from fluoridated salt and some naturally fluoridated water areas. Such arguments are not convincing because the biometric of exposure used was fluoride levels in the urine, which is a measure of total dose of fluoride and is independent of the source. Moreover, the range of exposure in Mexico City was within the range of fluoride levels in the urine of adults in the U.S. This point was further confirmed by a subsequent national study of the urine fluoride levels in pregnant women in Canada. This study found that levels of fluoride in the urine of Canadian women living in fluoridated communities were almost identical to the levels in Mexico City, namely 0.87 ppm in Canada versus 0.91 ppm in Mexico City.²⁴

As far as the politics of fluoridation are concerned, it is significant that some of the world’s leading neurotoxicologists, like Phillipe Grandjean (mercury specialist) and David Bellinger (lead specialist), are now participating in this research as well as reviewing the literature.^25,26 They now see fluoride’s neurotoxicity in the same vein as that of lead, arsenic, mercury and other well-established neurotoxicants.

It should also be stressed that in addition to the fifty-three IQ studies discussed above, there are many other animal, human, biochemical and cellular studies that provide an overwhelming weight of evidence that fluoride is neurotoxic. These include one hundred thirty human brain studies;²⁷ two hundred forty-one animal brain studies;²⁸ thirty-three cellular brain studies;²⁹and thirty review studies.³⁰

FLUORIDE AND HYPOTHYROIDISM

In the 1930s, ’40s and ’50s, doctors in Argentina, France and Germany used sodium fluoride to lower the activity of the thyroid gland for those suffering from hyperthyroidism (overactive thyroid gland).^{31 -37} Despite this knowledge, government agencies in the U.S. and other fluoridating countries have never seen fit to investigate a possible relationship between fluoride exposure and the rising level of hypothyroidism in their countries. Only recently have scientists reviewed the matter.^38-41

A 2018 study, reported that while they could find no relationship between fluoride exposure and TSH levels (thyroid stimulating hormone and an indicator of hypothyroidism) and fluoridation status among the general population, they did find that for those who had low or even borderline iodine intake, fluoride exposure was associated with an increase in their TSH levels.⁴²

The importance of this finding is that it gives a very plausible mechanism for why fluoride might lower IQ in children born to mothers with high fluoride exposure. When the fetus comes into existence it has no thyroid gland. It is entirely dependent on the mother’s thyroid levels for its early mental development. So any depression in the mother’s thyroid hormone levels will increase the risk of lowered IQ in their offspring (see Vyvyan Howard’s explanation of this situation in a PowerPoint presentation he gave in New Zealand in 2018).⁴³

WARNING PREGNANT WOMEN

One of the sad consequences of the medical community’s acceptance of the safety-and-effectiveness argument for water fluoridation, based upon dogma rather than upon the latest science, is that many doctors are oblivious of these findings. The result is that women are not being warned to avoid fluoride exposure during pregnancy. They are not being warned by their doctors, by health departments, by professional bodies or by the media. It has been left to non-governmental bodies like FAN to get the word out the best we can via social media, the Internet (see the Moms 2B Campaign),⁴⁴ press releases,⁴⁵ leaflets and talks. We have been trying to do so since 2017, but it is an extremely difficult task, as is the continuing battle to try to end the well-entrenched practice of water fluoridation.

LAWSUIT PROVIDES NEW HOPE

In November 2016, the Fluoride Action Network, along with Food & Water Watch, the American Academy of Environmental Medicine, the International Academy of Oral Medicine and Toxicology, Moms Against Fluoridation, the Organic Consumers Association and individuals, petitioned the EPA⁴⁶ to ban the deliberate addition of fluoride to public drinking water under provisions in the Toxic Substances and Control Act.

We argued that “[t]he risk to the brain posed by fluoridation additives is an unreasonable risk because, inter alia, it is now understood that fluoride’s predominant effect on tooth decay comes from topical contact with teeth, not ingestion. Since there is little benefit in swallowing fluoride, there is little justification in exposing the public to any risk of fluoride neurotoxicity, particularly via a source as essential to human sustenance as the public drinking water and the many processed foods and beverages made therefrom. The addition of fluoridation chemicals to water thus represents the very type of unreasonable risk that EPA is duly authorized to prohibit pursuant to its powers and responsibilities under Section 6 of TSCA, and Petitioners urge the Agency to exercise its authority to do so.”

In September 2017⁴⁷ the EPA rejected our petition on its scientific merits. In response to an appeal from FAN, a federal court denied EPA’s motion to dismiss in December 2017.⁴⁸

Also in December 2017⁴⁹ the EPA argued that no other studies should be added to the case after our petition was first delivered to them in November 2016. The court disagreed with EPA⁵⁰and ruled to allow new studies, such as those by Bashash and others discussed above. A trial date has been set to take place in federal district court in San Francisco in August 2019.

We are confident that we can win this case. In order to do so, it will require us to demonstrate three things: 1) that fluoride poses a hazard to the developing brain; 2) that there is a risk at current exposure levels (from all sources combined) in fluoridated communities; 3) that this is an unreasonable risk because there are other ways that tooth decay can be prevented.

Moreover, even if fluoride is one of those alternatives, there are other and more appropriate ways of delivering fluoride to the surface of teeth than putting fluoride into the drinking water. Indeed, the majority of countries worldwide that do not fluoridate their water have actually demonstrated this over many years.

SUMMARY AND CONCLUSIONS

There are many ethical and scientific arguments against the seventy-year practice of water fluoridation. The evidence that swallowing fluoride reduces tooth decay remains weak. Not a single randomized controlled trial has been attempted to demonstrate this, and promoters have relied on studies with far weaker methodologies.⁶⁵ Meanwhile, the number of studies that indicate harm can be caused, even at the doses experienced in fluoridated communities, has been growing, particularly studies on the brain.^{20,22,24,42,46}

With such risks on the table, it is unconscionable, in our view, that governments continue to promote the deliberate addition of a known neurotoxic and endocrine-disrupting substance to the drinking water of millions of people, most of whom have not been informed of the risks involved, or been given the opportunity to give—or refuse—their consent on the matter.

SIDEBARS

ELEVEN ARGUMENTS WHY FLUORIDATION SHOULD BE ENDED

1. Fluoridation is unethical. Using the public water supply to deliver dental therapy goes against all recognized principles of modern pharmacology and ethical healthcare practice. It imposes medication on all water consumers indiscriminately and without the individual’s informed consent. These include the unborn, bottle-fed infants, persons with chronic diseases known to be aggravated by fluoride (such as poor kidney function), the poorly nourished (such as those with low iodine intake) and the elderly. It does so with uncontrolled dosage, no monitoring of adverse effects and no possibility of avoiding treatment for most, if not all, people. This is especially true for those on a low-income budget who simply cannot afford avoidance measures like reverse osmosis filtration systems.

2. Fluoridation is unusual. The vast majority of countries worldwide do not fluoridate their drinking water. Out of one hundred ninety-six countries, only twenty-four have any fluoridated cities, and of those, only ten, including the U.S., fluoridate more than half their population. Ninety-five percent of the world’s people drink water without artificial fluoridation. Over half of those who do, live in the U.S. In Europe, where forty-three out of forty-eight nations have no water fluoridation, 98 percent of the population is not forced to drink fluoridated water. A few European countries (namely France, Germany, Switzerland and Austria) have fluoridated salt available, but people are not forced to buy this salt, as non-fluoridated salt is also available. Despite this, World Health Organization (WHO) data61 indicate that since the 1960s, tooth decay in twelve-year-olds has been coming down as fast in non-fluoridated countries as in fluoridated ones.

3. Children in fluoridated communities are being grossly over-exposed to fluoride. In the U.S. and other fluoridated countries, there has been a dramatic increase in young children and teens in the prevalence of dental fluorosis (discoloration of tooth enamel caused by low-level systemic fluoride toxicity during tooth formation). This condition indicates that children have been grossly over-exposed to fluoride before their permanent teeth have erupted. The latest national survey indicates that over 60 percent of U.S. teens have dental fluorosis.^52,53 Of those, 24 percent have moderate and nearly 2 percent have severe levels of the disease. These levels can produce yellow and brown staining and structural damage to the enamel. To put this into context, the early promoters of fluoridation anticipated only 10 percent of the children in fluoridated communities would be affected by this condition, and these would be only in the “very mild” category. They believed that this was an acceptable trade-off for reducing tooth decay. Even avid promoters of fluoridation no longer accept that the current prevalence rates as acceptable but they tend to blame other sources of fluoride—rather than water fluoridation—for the dramatic increase. In reality, every source of fluoride ingested contributes to this prevalence. The contribution from water fluoridation can be eliminated with a simple policy change.

4. Fluoride has the potential to damage many other tissues. Because of the prevalence of dental fluorosis, there is no question that fluoride can damage the developing teeth. Nor is there any question from the evidence provided in countries with large areas of endemic fluorosis (such as India and China) where millions of people have both dental and skeletal fluorosis, that high doses of fluoride can damage other tissues including bones, connective tissue, the brain, the endocrine system, the gut and kidneys. The Indian Ministry of Health & Family Welfare,⁵⁴ provides an excellent description of the problems faced by thousands of villages poisoned by fluoride. For the Western world, much of this evidence was provided in a comprehensive review of the literature conducted by the National Research Council of the National Academies in 2006.¹⁶ What has emerged since 2006 is a growing body of evidence that this harm can occur at doses experienced in artificially fluoridated communities.

5. Fluoridation is unnecessary. Fluoride is not an essential nutrient. No one has ever demonstrated that a single biological process in the human body needs fluoride to function properly. There is no such thing as a “fluoridedeficiency” disease. Children can have perfectly good teeth without ingesting fluoride. Even promoters of water fluoridation admit that the predominant benefit of fluoride is topical, not systemic.^55-58 Thus, it is morally indefensible to force people to ingest fluoride via the public water supply, when for those who want fluoride, fluoridated toothpaste is universally available. Moreover, the fluoride used in toothpaste is pharmaceutical grade whereas the fluoride used to fluoridate water is an industrial grade hazardous waste product from the phosphate fertilizer industry.²⁵

6. Today’s fluoride is worse. The fluoridating chemical used in over 90 percent of the fluoridating communities in the U.S. is a substance called hexafluorosilicic acid (H2SiF6). This substance is removed from the scrubbing systems of the phosphate fertilizer industry as a 23-25 percent solution. It is contaminated with trace amounts of other toxic substances including aluminum, arsenic, lead and radioactive isotopes (the same ore that is mined for fluoride in Florida is also mined for uranium). Ironically, this waste product cannot be dumped into the sea by international law, but health authorities blandly allow it to be put untreated into the public water supply!

7. Fluoride is very toxic and nature has developed protection mechanisms for many living things. For lower creatures like bacteria and fungi, there are genes—switched on by high levels of fluoride—which code for proteins called fluoride exporting proteins (FEX proteins). These proteins are located in the cellular membranes and pump fluoride out of the cell.²⁶ In mammals, the kidney excretes about 50 percent of fluoride ingested each day from healthy individuals, and most of the rest is rapidly sequestered in hard tissues like the bones. Importantly, the human breast appears to act as a fluoride filter for the new born baby. The level in mothers’ milk is remarkably low (0.004 ppm).²⁷ Thus, a bottle-fed baby, when the formula is made up with fluoridated tap water (0.7 to 1.2 ppm), will get approximately two hundred times more fluoride than a breastfed infant (that is, two hundred times more than nature intended).

8. Fluoridation is unscientific. Fluoridation is promoted with PR techniques like endorsements, not with sound
science. Most of the endorsements were made shortly after the U.S. Public Health Service endorsed water fluoridation in 1950 with virtually no science on the short-term—let alone long-term—health effects. Citizens should be very wary of taking such endorsements at face value unless they are accompanied by an up-to-date review of the literature—and very few are. Incredibly, in over seventy years there has been no randomized control trial (RCT) to demonstrate that swallowing fluoride lowers tooth decay. As far as the U.S. Food and Drug Administration (FDA) is concerned, an RCT is the gold standard for approving new drugs. According to the FDA, fluoride is an unapproved drug²⁸ and the FDA has never approved fluoride tablets for ingestion. Many decision makers and journalists around the world are impressed when they read the notorious statement from the CDC in 1999 that “Fluoridation is one of the top public health achievements of the 20th century.”⁶³ However, what they may not realize is that this statement did not come from the CDC itself (which has about thirty thousand employees, many of whom are highly qualified in many medical fields as well as toxicology) but from the CDC’s small Oral Health Division with only thirty employees, most of whom only have dental qualifications. Moreover, their job is defined as promoting fluoridation. They even admit to not following—or being responsible for—the science pertaining to fluoride’s harmful effects. Journalists and others have been impressed by a public relations exercise by a promotional body, not by a body that maintains a careful overview of any harm the practice may be causing.

9. Health risks are ignored in fluoridated countries. Sadly, because the imposed dental practice of water fluoridation is so entrenched in the psyche of the medical, dental and public health establishments in fluoridated countries, neither governments nor the mainstream media are warning the public about the large and growing
body of scientific research30 that shows that fluoride exposure poses many health risks.

10. Fluoridation violates the precautionary principle. The scientific evidence that swallowing fluoride lowers tooth decay is weak,³¹ but the weight of evidence that it causes harm to the developing brain is so one-sided, that to wait for further studies before halting the deliberate addition of fluoride to water is a rash and irresponsible public health position.

11. Fluoridation violates the principles of environmental justice. The addition of fluoride to public water is an environmental injustice to people living in poverty in fluoridated areas who do not have access to alternative water
sources and are captive to tap water for all their water needs. Moreover, it is well established that those with poor
nutrition are more vulnerable to fluoride’s toxic effects, and poor nutrition is more likely to occur among those
with low incomes.

REFERENCES
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46. Connett M. 2016. Petition to the U.S. Environmental Protection Agency under Section 21 of the Toxic Substances Control Act (TSCA), 15 U.S.C. § 2620, invoking Section 6 of TSCA, 15 U.S.C. § 2605(a), on behalf of several groups and individuals. November 22. http://fluoridealert.org/wp-content/uploads/epa-petition.pdf.
47. U.S. EPA (Environmental Protection Agency). 2017. Federal defendants’ motion to dismiss. In the United States District Court for Northern California, San Francisco Division. Case 3:17-cv-02162-EMC, Document 28. September 25. http://fluoridealert.org/wp-content/uploads/tsca.epa-motion-to-dismiss.9-25-17.pdf.
48. United States District Court for Northern California. 2017. Order denying defendant’s motion to dismiss. Case No. 17-cv-02162-EMC, Docket No.28. December 21. http://fluoridealert.org/wp-content/uploads/tsca.12-21-17.denies-epa-motion-to-dismiss.pdf.
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50. United States District Court for Northern California. 2018. Order Denying Defendant’s Motion to Limit Review to the Administrative Record. Case 3:17-cv-02162-EMC, Document 53, February 7. http://fluoridealert.org/wp-content/uploads/tsca.2-7-18.court-denies-epa-motion-to-limit.pdf.
51. WHO Data, http://fluoridealert.org/issues/caries/who-data/.
52. Wiener et al. 2018. Dental fluorosis over time: a comparison of national health and nutrition examination survey data from 2001-2002 and 2011-2012. Journal of Dental Hygiene. Feb;92(1):23-29.
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55. Centers for Disease Control & Prevention. 1999. Achievements in public health, 1900-1999: fluoridation of drinking water to prevent dental caries. Morbidity and Mortality Weekly. October 22, 1999 /48(41);933-940. http://fluoridealert.org/wp-content/uploads/cdc-mmwr.oct-22-1999.pdf.
56. Centers for Disease Control & Prevention. 2001. Recommendations for using fluoride to prevent and control dental caries in the United States. Morbidity and Mortality Weekly Review. Recommendations and Reports, August 17, 2001 / 50(RR14);1-42.
57. Ibid at 16.
58. Featherstone JD. 2000. The science and practice of caries prevention. Journal of the American Dental Association. July: 131(7):887-99.
59. Fluoride Action Network, Phosphate Fertilizer Industry, see http://fluoridealert.org/articles/phosphate01/
60. Li et al. 2013. Eukaryotic resistance to fluoride toxicity mediated by a widespread family of fluoride export proteins. Proceedings of the National Academy of Sciences of the United States of America. Nov 19;110(47):19018-23.
61. Ibid at 16, page 40, https://www.nap.edu/read/11571/chapter/4#40.
62. Moore, Robert J. 2005. Fluoride is an unapproved drug. Letter from Food and Drug Administration to Daniel Stockin. www.fluoridealert.org/wp-content/uploads/fda-2005a.pdf.
63. Centers for Disease Control & Prevention. 1999. Ten Great Public Health Achievements–United States, 1900-1999. Morbidity and Mortality Weekly Review. December 24, 1999 / 48(50);1141
64. Fluoride Action Network. Study fluoridealert.org/studytracker/.
65. Iheozor-Ejiofor Z, et al. 2015. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews. June 18. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010856.pub2/abstract.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Spring 2019

*Original article online at https://www.westonaprice.org/health-topics/environmental-toxins/water-fluoridation/#comments

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