Fluoride Action Network

Tea Intake Is a Risk Factor for Skeletal Fluorosis

Fluoride Action Network | April 2012 | By Michael Connett

Due to the high levels of fluoride in tea drinks, people who regularly drink tea are at an elevated risk of fluoride toxicity. A number of recent studies, for example, have found that heavy tea drinkers can develop skeletal fluorosis – a bone disease caused by excessive intake of fluoride. Since skeletal fluorosis can closely resemble common forms of arthritis, it is commonly misdiagnosed as being arthritis. As a result, tea drinkers with skeletal fluorosis can go many years before they are correctly diagnosed. As noted by a team of Chinese researchers who have carefully studied the impacts of tea intake on bone health, “it is certain that some heavy-tea drinkers suffering from fluorosis from tea-drinking might not be diagnosed.” (Yi & Cao 2008).

Excerpts from the Scientific Literature (U.S. & England):

“We describe a 48-yr-old American woman who developed SF from brewed tea. . . .Our patient had elevated bone mineral density . . ., severe chronic bone and joint pain, and kyphosis after consuming 1-2 gallons of brewed orange pekoe tea daily for more than three decades. F(-) levels were high in her serum, urine, and clippings of fingernails and toenails, as well as in our reproduction of her beverage. Renal function was normal. . . . CONCLUSION: Our patient shows that [skeletal fluorosis] can result from chronic consumption of large volumes of brewed tea.”
SOURCE: Izuora K, et al. (2011). Skeletal fluorosis from brewed tea. J Clin Endocrinol Metab. 96(8):2318-24.

“A 45-year-old white male was found to have radiographic findings of a diffusely dense appendicular skeleton, mild trabecular thickening, and multiple thoracic compression fractures indicating structural weakness. Bone mineral density was above the expected range for his age on the lumbar spine and femoral neck. Social history was significant for well-water consumption and daily instant-tea ingestion of 68 oz (1.89 L) for the past 10–15 years. . . . The differential diagnoses included osteopetrosis, Paget disease, hyperparathyroidism, renal osteodystrophy, osteomalacia, and skeletal fluorosis. Given the patient’s history of well-water and instant-tea consumption, radiographic findings, and increased plasma fluoride [7 umol/L], the diagnosis of skeletal fluorosis was given. Fluoride sequesters in bone and enhances osteoblast action, thus toxicity leads to dense but brittle bones. The high concentrations of fluoride in instant tea preparations (1) and groundwater contamination with fluoride (2 ) may both have contributed to this patient’s condition.”
SOURCE: Isbel TS, Villareal-Armamento R. (2010). What Is Your Guess? A Case of Thick but Brittle Bones and Instant Tea. Clinical Chemistry 56(6):1041-42.

“A 49-year-old woman from the state of Illinois, U.S.A., was referred for chronic, widespread, musculoskeletal aches and pains accompanying dense bones.  At age 31 years, she underwent hysterectomy without oophorectomy and had not yet experienced symptoms of menopause.  In her mid-30’s, she became “tired and sore”, and was eventually diagnosed with fibromyalgia by a rheumatologist who reported no inflammatory changes and a positive tender point exam in a fibromyalgic distribution.  She was also found to have  osteoarthritis that  was  particularly  severe  in  her  knees.   . . . Appreciation of the significant amounts of F in some modern preparations of  tea suggested to us that [skeletal fluorosis] caused our patient’s high bone mass when she recounted her remarkable volume of instant tea consumed over three decades.  In fact, her beverage, made extra strength in tap water with ~ 1.2 ppm F-, contained 5.8 ppm F- on the day we examined her.  In the U.S.A., this F- concentration exceeds the EPA’s primary standard (enforceable) of 4.0 ppm F- for drinking water, the FDA’s limits spanning  1.4 – 2.4 ppm F- for bottled water or beverages, and the PHS’s optimum levels ranging from 0.7 – 1.2 ppm F- for community water fluoridation.”
SOURCE: Whyte MP, et al. (2008). Skeletal fluorosis from instant tea. J Bone Miner Res. 23(5):759-69.

“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.

“Tea drinking remains popular in the United States and increasingly is suggested to promote health. We caution that skeletal fluorosis can result from consumption of excessive amounts of instant tea because of substantial fluoride levels in some commercial preparations. A 52-year-old white woman consulted in 1998 for dense lumbar vertebras discovered after twisting her back. Spinal discomfort and stiffness for 5 years reflected ‘disc disease.’… Skeletal discomfort intensified during the subsequent year, and included new neck and scapular pain and elbow and knee arthralgias. Bone and joint pains, acquired axial osteosclerosis, well water, soap manufacturing, and periodontal disease suggested skeletal fluorosis… Our encounter with this patient calls for better understanding of the amounts and systemic effects of fluoride in various teas.”
SOURCE: Whyte MP, et al. (2005). Skeletal fluorosis and instant tea. American Journal of Medicine 118:78-82.

“It is possible that fluoride intake from tea may be sufficient to cause fluorosis, and I report here a case which gives some evidence for this. . . . A woman of 55 had been crippled by arthritis for about 25 years. . . . X-rays from the local hospital showed spinal disc degeneration but no obvious signs of fluorosis; some discs showed possible signs of osteoarthritis, and there were some exostoses. . . . She was drinking 3-4 pints of tea daily, and fluoride intake, measured with a specific fluoride electrode, reached over 9 mg. daily. . . . Little more than 3 months after stopping tea-drinking she reported that pain had diminished to the point where she was almost able to do without analgesics, and that mobility had increased so that she had been able to take on a job as representative, involving a considerable amount of walking. The improvement continued, and after 6 months she reported that she was virtually free of pain, and considered she could do without drugs. . . . Possibly some cases of pain diagnosed as rheumatism or arthritis may be due to subclinical fluorosis which is not radiologically demonstrable.”
SOURCE: Cook HA. (1971). Fluoride studies in a patient with arthritisThe Lancet 1: 817.