Fluoride Action Network

Gastrointestinal Problems Among Individuals with Skeletal Fluorosis

Fluoride Action Network | March 2012 | By Michael Connett

Humans suffering from skeletal fluorosis are known to suffer from an increased occurrence of gastrointestinal disorders. When fluoride intake is reduced, these gastrointestinal problems are among the first symptoms to disappear. The following are some of the studies that have examined this issue:

“It is clear from the observations presented in this article that fluoride damages teeth, skeletal and non–skeletal systems including gastrointestinal mucosa in children. . . . Skeletal fluorosis and non- skeletal manifestations occur after long term exposure but gastrointestinal mucosa is more vulnerable to fluoride toxicity in lower age groups.”
SOURCE: Kumar T, Takalkar A. (2010). Study of the effects of drinking water naturally contaminated with  fluorides on the health of children. Biomedical Research 21:423-27.

“A health survey of 1135 children and 1475 adults living in Sanganer Tehsil, Rajasthan, India, revealed a wide range of gastrointestinal (GI) discomforts associated with fluoride (F) in the groundwater in over 30 village areas. . . . The main complaint of children and adults was stomach ache, followed by nausea and a bloated feeling, with males more prone to these effects than females.”
SOURCE: Sharma JD, et al. (2009). Gastric discomforts from fluoride in drinking water. Fluoride 42:286–291.

“Among the non-skeletal manifestations [of skeletal fluorosis], gastrointestinal disturbances are well known and present with loss of appetite, nausea, abdominal pain, flatulence, constipation, and intermittent diarrhea mimicking irritable bowel syndrome. The patient in our report presented with symptoms like those of enteropathic arthritis and the diagnosis of fluorosis could have been missed if attention had not been given to the increased density in the pelvic bones and ligamentous calcification.”
SOURCE: Gupta R, et al. (2007). Skeletal fluorosis mimicking seronegative arthritis. Scandinavian Journal of Rheumatology 36:154-55.

“We describe 4 patients evaluated at our Metabolic Bone Disease Clinic from May 1, 1997, to July 1, 2006, whose bone disorders resulted from chronic fluoride exposure due to excessive tea intake. Three of these patients had toxic serum fluoride levels (> 15 micromol/L). Although the clinical presentation of the patients varied, all 4 had an unexpectedly elevated spine bone mineral density that was proportionately higher than the bone mineral density at the hip. Other clinical features included gastrointestinal symptoms such as nausea, vomiting, and weight loss; lower extremity pain sometimes associated with stress fractures of the lower extremities; renal insufficiency; and elevated alkaline phosphatase levels. Readily available, tea often contains high levels of fluoride. Obsessive-compulsive drinking behaviors and renal insufficiency may predispose to excessive fluoride consumption and accumulation. The current cases show that fluoride-related bone disease is an important clinical consideration in patients with dense bones or gastrointestinal symptoms and a history of excessive tea consumption. Furthermore, fluoride excess should be considered in all patients with a history of excessive tea consumption, especially due to its insidious nature and nonspecific clinical presentation.”
SOURCE: Hallanger Johnson JE, et al. (2007). Fluoride-related bone disease associated with habitual tea consumption. Mayo Clinic Proceedings 82(6):719-24.

“Non-ulcer dyspeptic complaints or gastrointestinal complaints were observed in all of the (fluorosis) patients before treatment. During the first impact assessment reduction in health complaints, especially in gastrointestinal discomfort, was most striking. Most of the patients ~ 70% showed relief in gastrointestinal complaints during first impact assessment. During the second impact assessment all of the patients showed relief from gastrointestinal complaints.”
SOURCE: Susheela AK, Bhatnagar M. (2002). Reversal of fluoride induced cell injury through elimination of fluoride and consumption of diet rich in essential nutrients and antioxidants. Molecular and Cellular Biochemistry 234-235:335-40.

“A prospective case-controlled study was performed to evaluate the gastrointestinal symptoms and mucosal abnormalities occurring in patients with osteofluorosis. Ten patients with documented osteofluorosis and ten age- and sex-matched healthy volunteers were included in the study… All patients with osteofluorosis had gastrointestinal symptoms, the most common being abdominal pain. Endoscopic abnormalities were found in seven patients with osteofluorosis. In all 7 of these patients, chronic atrophic gastritis was seen on histology. Electron microscopic abnormalities were observed in all 10 patients with osteofluorosis. These included loss of microvilli, cracked-clay appearance, and the presence of surface abrasions on the mucosal cells. None of the control subjects had any clinical symptoms or mucosal abnormalities. It was concluded that gastrointestinal symptoms as well as mucosal abnormalities are common in patients with osteofluorosis.”
SOURCE: Dasarathy S, et al. (1996). Gastroduodenal manifestations in patients with skeletal fluorosis. Journal of Gastroenterology 31:333-7.

“The present study was conducted to assess the prevalence and severity of non-skeletal manifestations, especially gastrointestinal disturbances, in an area of skeletal and dental fluorosis… The subjects, numbering 1958 inhabitants belonging to 489 families residing in four endemic villages of Faridabad District of Haryana State, were interviewed on health complaints… It is concluded that in an endemic (fluorosis) zone, where the inhabitants are consuming water of high fluoride content, the occurrence of gastrointestinal complaints – viz., loss of appetite, nausea, abdominal pain, flatulence, constipation and intermittent diarrhoea – is one of the early warning signs of fluoride toxicity and fluorosis. When water with negligible amounts of fluoride (safe water) is provided, the complaints disappear within a fortnight.”
SOURCE: Susheela AK, et al. (1993). Prevalence of endemic fluorosis with gastro-intestinal manifestations in people living in some North-Indian villages. Fluoride 26: 97-104

“A prospective case controlled study was conducted to evaluate the role of fluoride as a possible aetiological factor for non-ulcer dyspepsia (NUD). Twenty patients with NUD and 10 age and sex matched healthy controls were subjected to clinical evaluation, upper gastrointestinal endoscopy and biopsies from the gastric antrum and duodenum… Fluoride levels in the drinking water, serum and urine were estimated using a ION 85 ion-analyser. These levels were significantly higher in patients with NUD than in controls (P less than 0.05).. The fluoride levels in serum and urine correlated with the symptoms, histological and electron microscopic abnormalities (P less than 0.05). It was concluded that chronic exposure to fluoride may result in NUD and should be considered in patients where other known cause of dyspepsia have been excluded.”
SOURCE: Gupta IP, et al. (1992). Fluoride as a possible etiological factor in non-ulcer dyspepsia. Journal of Gastroenterology and Hepatology 7:355-9.

“The mean urinary F level (3.55 ppm) and workers with more than 4 ppm urinary F levels (30.3%) were significantly higher in workers with burning epigastric pain than in workers without burning epigastric pain.”
SOURCE: Desai VK, et al. (1986). Symptomatology of Workers in the Fluoride Industry and Fluorspar Processing Plants. Studies in Environmental Science 27:193-99.

“The onset of disease with gastrointestinal symptoms, especially colitis and arthritis in the lower spine, as in this case, has been frequently observed by one of us in chronic fluorosis.”
SOURCE: Waldbott GL, Lee JR. (1978). Toxicity from repeated low-grade exposure to hydrogen fluoride–Case report. Clinical Toxicology 13: 391-402.