A new study, documenting a case of skeletal fluorosis from excessive tea consumption in the United States, made headlines in the press this week. The study, authored by a team of researchers at Washington University School of Medicine in Missouri, was published in the January issue of the American Journal of Medicine (1).

In the concluding paragraph of the study, the authors write:

“Our concern is that skeletal fluorosis might result from drinking instant teas, especially when excessive volumes in hot environments or extra-strength preparations are consumed, or when fluoridated or fluoride-contaminated water is used.”

The subject of the authors’ study is a 52-year old woman from St. Louis. The cause of the woman’s fluorosis appears two-fold: On one hand, she consumed well water with 2.8 ppm fluoride, and on the other hand, she drank up to 1-2 gallons per day of iced tea.

After learning of the woman’s high tea consumption, the authors analyzed the levels of fluoride in various types of instant tea. They found that levels ranged from 1 ppm to 6.5 ppm. The latter value, found in a sample of Lipton’s Instant Tea, exceeds the U.S. Environmental Protection Agency’s Maximum Contaminant Level for fluoride (4 ppm).

The resulting skeletal fluorosis that the woman developed from drinking well-water and instant tea, caused bone and joint pain throughout her body – not just in the spine where the bone changes were most advanced. The bone and joint pains included “neck and scapular pain and elbow and knee arthralgias.”

Perhaps the most revealing finding of the study, however, is the following:

Between 1993 and 1998, the woman went to several doctors to find out what might be causing the stiffness and pain in her back. The doctors took x-rays of her spine and found evidence of “marked osteosclerosis.” However, the doctors failed to diagnose her condition as fluorosis. Instead, they said she suffered from “disc disease.”

It wasn’t until the woman consulted Dr. Michael Whyte in 1998, that the correct diagnosis of skeletal fluorosis was made.

The history of misdiagnosis which the woman experienced – despite having rather marked changes in her spine – raises the question of how many other people in the U.S., particularly those with less obvious bone changes, have been similarly misdiagnosed. Many independent scientists that have examined the scientific literature on skeletal fluorosis have raised a similar concern (2-6).

In light of the new study on skeletal fluorosis in the U.S., I have compiled the following series of statements from scientists warning of the probability that skeletal fluorosis is occurring in some individuals, but is being misdiagnosed as one of a series of other bone/joint diseases (e.g. osteoarthritis; spondylosis; renal osteodystrophy; and Diffuse Idiopathic Skeletal Hyperostosis).

“Our case report illustrates dramatically that fluorosis can lead to severe disability while closely mimicking a wide variety of other disorders… We believe increased awareness of this unusual disease is needed to enable physicians to make the proper diagnosis.” (2)

“Although skeletal fluorosis has been studied intensely in other countries for more than 40 years, virtually no research has been done in the U.S. to determine how many people are afflicted with the earlier stages of the disease, particularly the preclinical stages. Because some of the clinical symptoms mimic arthritis, the first two clinical phases of skeletal fluorosis could be easily misdiagnosed [as arthritis]… Even if a doctor is aware of the disease, the early stages are difficult to diagnose.” (3)

“It should also be noted that chronic fluorosis is not easily diagnosed, and that few physicians have ever seen a case. Three of the cases reported in the U.S. literature were not diagnosed until post-mortem examination revealed excessive fluoride content in the bone. It is possible that the disease may be occurring to some extent without having been recognized.” (4)

“It is quite possible that many cases of (skeletal fluorosis) have gone misdiagnosed and unreported over the years… The state of knowledge among practicing physicians, even those in non-fluoride areas, concerning the diagnosis of skeletal fluorosis seems to be deficient and should be more carefully assessed.” (5)

“Symptoms of fluoride poisoning are actually common in this country. The question is not at all whether they occur, but when and how often they are produced by fluoride… It is true that reports (of skeletal fluorosis in the U.S.) are few. This is both the cause and the effect of the fact that physicians, by and large, are unaware that such a thing exists. It is hardly mentioned in the textbooks or in the medical literature.” (6)

“One common feature of the three manifestations of chronic fluorine intoxication is that isolated cases may be difficult to diagnose.” (7)

References:

1. Whyte MP, Essmyer KE, Gannon FH, Reinus WR. (2005). Skeletal fluorosis and instant tea. American Journal of Medicine 118(1):78-82.
2. Fisher RL, et al. (1989). Endemic fluorosis with spinal cord compression. A case report and review. Archives of Internal Medicine 149: 697-700.
3. Hileman B. (1988). Fluoridation of water: Questions about health risks and benefits remain after more than 40 years. Chemical and Engineering News August 1, 1988, 26-42.
4. Groth, E. (1973), Two Issues of Science and Public Policy: Air Pollution Control in the San Francisco Bay Area, and Fluoridation of Community Water Supplies. Ph.D. Dissertation, Department of Biological Sciences, Stanford University, May 1973.
5. Prival MJ. (1972). Fluorides and human health. Center for Science in the Public Interest, Washington D.C.
6. Exner FB. (1957). Fallacies of the fluoridation thesis. In: J Rorty, ed. (1957). The American Fluoridation Experiment. Delvin-Adair Co, New York. pp. 29-153.
7. Roholm K. (1937). Fluoride intoxication: a clinical-hygienic study with a review of the literature and some experimental investigations. London: H.K. Lewis Ltd.

Media reports on Study:

• Harmful Fluoride Levels Found in Instant Iced Tea – FOX News/WebMD, January 26, 2005.
• Tea-drinking habit led to rare bone disease – St. Louis Dispatch, January 26, 2005.
• Potentially harmful fluoride levels found in some instant teas – Press Release from Washington University School of Medicine, January 25, 2005.

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