Back in June, the Asheville-Buncombe Food Policy Council sent a letter to Mayor Esther Manheimer and City Council “requesting the city to end the artificial fluoridation of our water supply.” Brevard, Franklin, Black Mountain and Woodfin have all cut fluoride from their water systems over the years, and the grassroots group, whose mission is to “create healthier food environments and improve healthy food access for all Buncombe County residents,” is urging Asheville to follow suit.

Since the 1950s, fluoride has been added to many public water supplies to prevent tooth decay, but the practice was controversial from the start. Recent research has raised serious health concerns, though the federal government still maintains that the additive is safe at recommended levels.

“There’s a valid discussion to be had regarding drinking water fluoridation,” says Manheimer. “Asheville is in a unique situation in that fluoride was added to the drinking water after a ballot referendum. Therefore, to remove fluoride from the drinking water, another ballot referendum is needed.”

Good intentions

“Water fluoridation had good intentions early on,” explains Timothy Ormond of HydroCycle Engineering, an Asheville-based consulting firm. “We now have a lot more information about public health concerns and effects that can be toxic, disrupting certain organ and enzyme functions.” These studies, says Ormond, a Food Council volunteer, weren’t available in 2008, the last time the city considered the issue.

On April 27, the letter points out, the U.S. Department of Health and Human Services lowered its recommended fluoride level to avoid dental fluorosis, which causes spots on children’s teeth. The federal government, however, doesn’t recognize any other health concerns related to fluoride.

However, recent studies published in the Journal of Epidemiology & Community Health and in the journal Environmental Health link fluoride consumption with hyperthyroidism and increased rates of attention deficit hyperactivity disorder; other studies link the chemical to lower IQ scores in children. The Food Council’s letter also notes that the National Research Council has recognized fluoride as an endocrine disrupter and that a study published recently in The Lancet called fluoride a “developmental neurotoxin.”

“There are benefits of fluoride for your teeth,” Ormond concedes, “but that’s assuming that it’s primarily used topically and not ingested.”

The various forms of fluoride added to drinking water, says Dr. Angela Hind, “harm the development of a child’s brain, both in utero and during childhood. This is significant, because children are consuming it in our tap water every day.” Hind, a physician specializing in internal medicine, says fluoride also leads to thyroid conditions. “In the ’50s, it was used as a medication to suppress overactive thyroids. Not as much was known about thyroid function then, but now we have an epidemic of thyroid disease in our country: One in eight women will develop a thyroid condition in their lifetime.”

Contentious history

Fluoridation has been a thorny issue locally for many years. In 1956, City Council decided to begin adding fluoride to Asheville’s water supply; in a referendum, however, Buncombe County voters overwhelmingly rejected the move. The resulting lawsuit reached the state Supreme Court, which ruled that a countywide referendum could not reverse a municipal decision.

Asheville began fluoridating its water in 1965 after a city referendum supported the practice. A second referendum, held in 1967 at opponents’ urging, upheld fluoridation.

The issue has been revisited several times; in 2008, local dentist Matthew Young compared putting fluoride in the water to drinking sunblock to prevent sunburns. After a lively debate, however, Council opted not to schedule another referendum.

“I think we have a lot more and better information than we used to,” says Ormond. “Ninety-seven percent of Western Europe doesn’t fluoridate its water.” And a 2012 World Health Organization study found equal or better declines in tooth decay rates in countries that don’t fluoridate their water (see chart).

The Food Council’s letter also points out that the fluoride added to our water is industrial, not pharmaceutical grade.

Industrial grade fluoride, notes Hind, is “scrubbed from the smokestacks of the phosphate fertilizer industry. It’s tainted with other industrial byproducts, including lead, arsenic and cadmium, and we’re also putting those things into our water, in very small amounts.”

Civil engineer Melanie Brethauer, a Food Council volunteer who works on water issues, says fluoridation falls through the regulatory cracks. “The FDA doesn’t regulate it because it’s not a drug. But the EPA doesn’t regulate it, because it isn’t being put in a river.”

Fluoride also occurs naturally in water, and though the Environmental Protection Agency doesn’t regulate “additives,” it does set a limit for total fluoride in drinking water that’s much higher than the revised HHS standard. The Food and Drug Administration regulates bottled water but not public water supplies.

The letter also asserts that fluoridation discriminates against economically disadvantaged residents. (Ironically, protecting poor children’s dental health has been one of the main arguments advanced by proponents of the practice.) “It’s a social justice issue,” Brethauer maintains. “I can drive and get bottled water, but what about people who don’t have cars or just can’t afford it?”

Waiting game

Asheville, notes Manheimer, recently “lowered the levels of fluoride in the water after the U.S. Department of Health and Human Services recommended a lower level.”

And in any case, she continues, there’s no point in addressing the issue until the city’s 2014 lawsuit against the state over control of Asheville’s water system is settled. Wake County Superior Court Judge Howard Manning ruled in the city’s favor last year; the state has appealed the decision.

Following is the full letter the Asheville Buncombe Food Policy Council sent to Mayor Esther Manheimer and the Asheville City Council on June 23, 2015:

Dear Honorable Mayor Manheimer and Asheville City Council:

The Asheville Buncombe Food Policy Council (ABFPC) was formed to: “create healthier food environments and improve healthy food access for all Asheville and Buncombe County residents.” Clean and safe water is not only critical for sustaining life and health through direct human consumption, but water is also an essential component in growing and producing healthy food for our community.

Based on a growing body of evidence, ABFPC is concerned about the practice of artificially fluoridating our water supply and is therefore respectfully submitting this request for consideration by the Asheville City Council to end the practice of artificial water fluoridation of our municipal water supply.

We would like to summarize some of the most urgent reasons to end artificial water fluoridation as well as the benefits to our community, citizens, and local businesses by ending this outdated practice.

Reasons to End Artificial Fluoridation

On April 27, 2015, the U.S. Department of Health and Human Services (HHS) acknowledged that the fluoride levels, which it previously promoted and encouraged as safe, has damaged children’s teeth. Because of the major increase in dental fluorosis (white spotted, yellow, brown and/or pitted teeth) in 41% of young teenagers, HHS announced that water fluoride levels should be lowered. 1

In addition to the well-documented condition of dental fluorosis, there is growing body of research demonstrating other adverse health impacts of water fluoridation, including:

Lowered IQ in children documented in 43 studies2
ADHD (attention deficit hyperactivity disorder)3
Hypothyroidism/Underactive thyroid4
The National Research Council of the National Academies has stated fluoride is an “endocrine disruptor.”5
A recent study published in the Lancet lists fluoride as a “developmental neurotoxin.”6

Fluoride is the only chemical that is added to the municipal water supply as a “medication” for humans. All other chemicals are added as part of the water treatment and disinfection process. Ingesting fluoride should be a personal choice with informed consent.

The Centers for Disease Control and Prevention (CDC) has acknowledged that the mechanism of fluoride’s benefits are mainly topical, not systemic.7 Since the purported benefit of fluoride is topical, and the risks are systemic, it makes more sense to deliver the fluoride directly to the tooth in the form of toothpaste. Since swallowing fluoride is unnecessary, and potentially dangerous, there is no justification for forcing people to ingest fluoride through their water supply.

By putting fluoride in the drinking water, the dose cannot be controlled, as people ingest varying amounts of water. This is of particular concern for infants and young children and especially those consuming infant formula made with fluoridated water. Infants who receive formula made with fluoridated water at the new HHS guideline level may receive an estimated 175 times more fluoride than a breast-fed infant.

The chemicals used to fluoridate water are not pharmaceutical grade. The form of fluoride added to the City water supply is hexafluoricsilicic acid and is obtained from a chemical plant located in Spruce Pine. Industrial grade fluoride chemicals are classified as hazardous wastes and may be contaminated with various impurities, including arsenic.

African-American and Latino children are more vulnerable to fluoride’s toxicity. According to the CDC’s national survey of dental fluorosis, African-American and Latino children have significantly higher rates of dental fluorosis than white children.8 The recognition that minority children appear to be more vulnerable to toxic effects of fluoride, combined with the fact that low-income families are less able to avoid drinking fluoridated water, has prompted prominent leaders in the environmental-justice movement to oppose mandatory fluoridation.

Our nearby communities of Brevard, Franklin, Woodfin, and Black Mountain do not add any fluoride chemicals to their water. And many other communities around the country and throughout the world are abandoning the practice of fluoridating their water. Since 2010, 176 communities have rejected fluoride, including major cities such as Portland, Oregon, Albuquerque, New Mexico, Wichita, Kansas and Calgary, Alberta. Additionally 97% of Western Europe has rejected water fluoridation.9

Asheville is known for its local food culture which is prized by residents and visitors alike. However many of these small businesses do not have the option to remove fluoride without implementing costly water treatment measures, such as distillation and reverse osmosis.
Benefits to Our Community by Ending Artificial Water Fluoridation

There are multiple benefits to be realized by the City by ending the practice of artificial water fluoridation, in addition to reducing the health risks cited above, including the following:

The artificial fluoridation of water incurs cost to the City and its tax payers. The cost savings by ending fluoridation can be used for other programs which benefit the community.

Several studies have documented that tooth decay does not increase when fluoridation is ended, including communities from Canada, former East Germany, Cuba and Finland.10

Asheville residents with concerns about fluoride seek out alternative sources of water, including bottled water, in order to avoid fluoride. By ending artificial fluoridation, these residents will be able consume City water, thus reducing the need to purchase bottled water and eliminating packaging from the waste stream.

Economically disadvantaged residents who lack the ability to afford non-fluoridated water will have the option to avoid fluoride in their water. As previously noted, this is of particular importance for bottle-fed infants in low income communities.

Removing fluoride will give local restaurants and food and beverage businesses the ability to provide “fluoride-free” water, beverage and food products that both they and their customers desire.

The above information represents the key reasons that ABFPC is requesting the City to end the artificial fluoridation of our water supply. We thank you for your consideration in this request and stand with you in striving to create healthier food environments and access for all of the residents of Asheville and our region.

Respectfully submitted, Asheville-Buncombe Food Policy Council References

1) on-fluoride-in-drinking-water

2) 3




6) Centers for Disease Control and Prevention. (2001). Recommendations for using fluoride to prevent and control dental caries in the United States. Mortality and Morbidity Weekly Review 50(RR14):1-42.

7) Beltran-Aguilar ED et al. (2005). Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis — United States, 1988–1994 and 1999—2002. MMWR Surveillance Summaries 54(3): 1-44. (Table 23)

8) Connett, Paul, PhD. (2012). “50 Reasons to Oppose Water Fluoridation.” Fluoride Action Network.


10) (Maupome? 2001; Kunzel & Fischer, 1997, 2000; Kunzel 2000; Seppa 2000)