Fluoride - The Inside Story

Thursday, 3rd October, 2013

Inside Story: Panacea or poison?

1 September 2013 by John Roberts Published in Sunday Business Post.

If you swallow more than a tiny "pea-sized" amount of fluoride, you are advised to contact a "poison control centre immediately".

Fluoride, the chief ingredient in toothpaste - a product most of us swill around our mouths with abandon twice a day - is highly poisonous. In fact, according to a Department of Health report, brushing your child's teeth at night could be a brush with death. "Swallowing as little as one-quarter of a tube (of fluoride toothpaste) may be life threatening for a one-year-old child," the Department warns, adding that a single tube of toothpaste has enough fluoride to kill a child up to about age 12.

In the US, all fluoridated toothpastes must carry a "poison warning". If you swallow more than a tiny "pea-sized" amount, you are advised to contact a "poison control centre immediately".

But there are no poison warnings on toothpaste in Ireland. A special Department of Health committee decided against introducing them here. "I think putting poison warnings on it is taking things a bit too far," said one of its members.

The truth is, if the government did sanction poison warnings on toothpaste, it would have some tricky questions to answer about what it's doing to our water.

Ireland is now the only country in Europe with a national policy of adding fluoride to the public's drinking water supply. By US reckoning, it is added at toxic levels. A glass of Irish tap water has the same dose of fluoride as a 'pea-sized' amount of toothpaste. Bizarrely, we are advised to spit out the toothpaste, to avoid fluoride's toxic effects. However, we are told that drinking the glass of fluoridated water - in unlimited quantities - is good for you. So which is it?

It is said that water fluoridation reduces tooth decay. However, 98 per cent of Europe - some of the most advanced nations in the world in healthcare terms - have rejected the practice. Many have done so due to health concerns. A recent European Commission report on the issue declared that "fluoride is not an essential element for human growth and development". On July 29, Israel became the latest country to ban the addition of fluoride to its water.


A cumulative poison

Of more concern for Ireland is the source of the fluoride in our water. The ingredient in toothpaste is pharmaceutical grade sodium fluoride. The fluoride added to water, at a rate of one part per million (1ppm), is a much more toxic industrial grade chemical called hydrofluosilicic acid. A highly corrosive acid, it is mainly sourced as a waste product of the phosphate fertiliser industry.

Hydrofluosilicic acid has never been tested for safety on humans. Neither has it ever been proven to reduce tooth decay. Unsurprisingly, then, the only medicinal substance disseminated to 73 per cent of Irish people daily, claimed to reduce an oral disease, remains unlicensed by the Irish Medicines Board.

Fluoride is also a cumulative poison, because the body retains 50 per cent of all it ingests. And if it's in the water supply, it's in everything made from that water too. You get a dose of fluoride every time you drink a cup of tea, coffee, a diluted drink, or any beverage produced from the public mains. It's in your soup, and your boiled potatoes. It's even in infant formula made up for fragile newborns. And babies and young children are most at risk as their bodies retain up to 90 per cent of ingested fluoride. According to the European Commission's 2011 report, Irish children are getting unsafe doses of fluoride every day.

Hip fractures, cancer, arthritic complaints, thyroid impairment and neurological problems have all been linked to fluoride in water. It even damages tooth enamel - the very thing it is put in the water to prevent.

As we approach 50 years of fluoridation in Ireland, have its effects in the Irish population been quantified? Worryingly, the Department of Health has no convincing answers to the effect of its water fluoridation policy, or to many other troubling questions related to this controversial practice.

According to the US National Research Council, the practice of fluoridating water supplies has been the subject of controversy since it began.

Initially a post-war US public health experiment, the idea to add fluoride to public water supplies met with fierce resistance. "Fluorides are known protoplasmic poisons," warned the American Medical Association. Although the experiments were aborted in 1950, the US Public Health Service rushed to fluoridate the entire US anyway. It sparked a major backlash and a bruised US government was forced to change tactics and begin a major push for international approval.

Ireland was the first European country to embrace the measure. The Health 'Fluoridation of the Water Supplies' Act was introduced to the Dáil in 1960 by the Fianna Fáil Minister for Health, Sean MacEntee. It was a deeply divisive bill and opposition health spokesperson Richie Ryan labelled it "one of the most repulsive pieces of legislation which has come before the Dáil".

"Frankly, I was worried," says Ryan. Now aged 84, the former solicitor, MEP and minister for finance has been revisiting his original concerns.

"There was a considerable amount of worrying scientific and medical evidence raising queries about the long-term effects of fluoride. If it was going to affect teeth, then it was going to affect the entire human skeleton. And very little research had been done on that," he says. "You are medicating the entire population for a lifetime, in order to confer a limited benefit on children up to 12 years of age. It's a clumsy treatment at best."

The young Fine Gael TD successfully forced through a late amendment to the 1960 Health Act, stating that "it shall be the duty" of future health ministers to carry out health studies. Fifty years on, no such general health studies have ever been conducted by the Department of Health.

"They don't want to be found in the wrong," says Ryan, of the Department's inaction. "No department of state ever wants to admit that what they have done is wrongful. Once they have an adopted line, they'll defend it to the last."
A failed Supreme Court challenge by Dublin woman Gladys Ryan (no relation) in the early 1960s, with Ryan leading the plaintiff's legal team, delayed the introduction of fluoridation here for three years. However, Dublin's fluoride taps were finally turned on in July 1964, just over 49 years ago.


Rejection in Europe

In Europe, water fluoridation has been defined by trepidation, aborted trials and outright rejection. Leading scientists fought its introduction. "Fluoridation goes against all principles of pharmacology - it's obsolete," says doctor Arvid Carlsson, a Nobel Laureate in Medicine who advised the Swedish government to reject the practice.

While fluoridation is compulsory by law in Ireland, it is prohibited by law in the Netherlands. Dutch fluoridation trials were halted in 1976 when adverse health effects emerged in the test towns. Even other parts of Ireland rejected it, when 25 out of 26 councils in the North voted against its introduction in 1996. Thus, apart from some local schemes in England and Spain, Europe's water remains fluoride free.

According to Ryan, fluoridation rejection across Europe went virtually unnoticed in Ireland. "The Department of Health issued bulletins if any country in the world introduced fluoridation. They never issued a bulletin when it was rejected."

Today, the US accounts for over half of the world's artificially fluoridated population. And the measure continues to divide the medical community there. In 1998, a union representing 1,500 scientists and other professionals at the US Environmental Protection Agency called for its immediate cessation. "Our members' review of the body of evidence over the last 11 years . . . indicate a causal link between fluoride/fluoridation and cancer, genetic damage, neurological impairment and bone pathology," it said in a statement.

Just nine other countries worldwide fluoridate more than 50 per cent of their water supplies, and the practice is on the retreat. In the last year, vast regions across Australia and Canada have voted fluoridation out. Israel has followed suit.

Major scientific reviews are now saying that the promises that water fluoridation is "safe and effective" are not backed by hard science.

In 2006, the US National Research Council (NRC) conducted the most comprehensive review yet on the safety levels of fluoride in water. The report "should be a wake-up call", said one of its authors. Thyroid impairment, moderate skeletal fluorosis (arthritis), and impaired glucose tolerance (type 2 diabetes), can all be caused by the levels of fluoride consumed in artificially fluoridated communities at 1ppm, said the NRC report.

A European Commission report on water fluoridation, published in 2011, re-affirmed that "there is continuous controversy over the benefit of fluoride and (fluoridation)". The EC's Scientific Committee on Health and Environmental Risk (SCHER) said the evidence that swallowing fluoride in water reduced decay was not convincing.

While it's true that decay rates have plummeted in Ireland since the 1960s by up to 70 per cent, tooth decay has declined at similar levels in virtually every other industrialised country worldwide, without the aid water fluoridation. World Health Organisation statistics reveal that most of our non-fluoridated European neighbours now have better teeth than in fluoridated Ireland.

The European Commission specifically dismissed the role of water fluoridation in its 2011 SCHER report. Decay declines have been achieved "independent of the fluoridation policies across the EU Member States" it stated. Other reviews have also debunked fluoridation's alleged decay-defying properties.

"Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high-quality research has been undertaken," concluded a major review at the University of York in 2000.

The truth is that decay has declined globally, including here in Ireland, due to many factors: changes in nutrition, improved oral hygiene, better education, as well as fluoridated toothpaste.

Senior Department of Health officials have admitted in the past that because of these factors, most Irish people don't need fluoride in their water. However, today, the Department's position seems to have hardened.

"Children in Ireland have poor tooth-brushing habits," a Department spokesperson told The Sunday Business Post. Irish kids also ate lots of "foods and drinks sweetened with sugar", it added. Because of these factors, water fluoridation must continue for everyone.

Evoking Ryan's description of a "clumsy treatment", it's not clear if the children drinking too many sugary soft drinks - the very target of fluoridation - are therefore even drinking the medicated tap water.


'Fluoridation works'

The Irish government continues to cling to the mantra that "fluoridation works". However, along with international dental authorities, the Department concedes that the original logic for fluoridation is now obsolete.

Back in the 1940s, they thought fluoride had to be ingested, to be incorporated into a child's developing teeth, making it more resistant to decay.

But they got it wrong. Recently, they've conceded it only works "topically", in the mouth, such as via toothpaste, which you spit out. Dental authorities, meanwhile, say ingesting fluoride systemically causes harm.

Numerous reviews, including the York Report, have said that fluoridation at 1ppm causes toxic effects in 50 per cent of people. And remarkably, these effects show up in the very organ fluoride is supposed to be protecting: the teeth. The condition is called dental fluorosis.


Dental fluorosis

Dental fluorosis is systemic fluoride poisoning of the teeth. It's a sign that the normal development of tooth enamel was impaired, and it is only caused by fluoride.

Fluorosis appears as white lines on teeth, and can cause discoloured stains. At severe levels (which can result from swallowing toothpaste), the teeth are pitted and chipped. The tooth enamel is totally destroyed. Severe enamel fluorosis is a toxic effect that causes structural damage to the tooth, according to the US NRC report in 2006. And fluorosis is on the rise in Ireland, according to a report from the Department of Health.

With this evidence that fluoridation damages teeth, far more convincing than evidence of any benefit, international experts say it's time to stop.

"Litigation is inevitable. Inaction in the face of evidence could be considered negligent," said Dr Hardy Limeback, past president of the Canadian Association of Dental Research, when he addressed TDs at the Oireachtas Health Committee in 2000. But the existence of fluorosis raises much more troubling questions about water fluoridation.

If 1ppm damages your teeth, the only visible part of your skeleton, surely it's damaging your bones too? And if ingesting fluoride via toothpaste can poison every organ in the human body, almost instantly, does ingesting fluoride via water have the same effects, just over a longer period of time? The evidence is alarming.

Fluoride in water has been linked to bone defects, neurological disorders, cancer, genetic damage, gastrointestinal issues, thyroid problems and arthritic complaints. There are now more than 1,000 scientific studies on the subject. The research incites heated debates, for a simple reason; the amount of fluoride known to cause this damage is minuscule.

Most therapeutic substances have a margin of safety of at least ten. This means that people can consume ten times a "recommended dose" without suffering ill effects. But based on dental fluorosis, fluoride's safety margin is less than one. And of even more concern, catastrophic health effects are seen at levels well below the normal "no effect" safety margin of ten.

An edition of the British Medical Association's New Guide to Medicines and Drugs states that just 8ppm can wreak havoc with the entire human body, causing bone disorders and degenerative changes on the kidneys, adrenal glands, central nervous system and reproductive organs. That is just eight times Ireland's recommended concentration.

The World Health Organisation admitted in 2008 that skeletal fluorosis (with adverse changes in bone structure) may be observed when drinking water contains 3-6mg per litre, just over three times Ireland's optimal level.

Studies indicate that thyroid function can be lowered at just 2.3 ppm. IQ in children may be lowered at levels as low as 1.9ppm. Other studies indicate hip fractures in the elderly may be increased at 1.5ppm, and tripled at over 4.3ppm.

This lack of safety margin concerned the US National Research Council. Because fluoride is freely available in the water supply, there's no controlling the dosage. It's prescribed by your thirst. Therefore anyone drinking fluoridated water at 1ppm, can easily ingest the same dose of fluoride as people drinking 4ppm, a concentration known to pose serious health risks.

"In other words, any effect seen at 4 mg/L is probably going to occur in some people at 1 mg/L, in the people with highest water consumption or in people with impaired fluoride excretion, but this might easily be missed in the sample sizes typically used in studies," says NRC panel member Professor Kathleen Theissan.

The NRC report also warned that there is little understanding of the fluoride levels which cause the early stages of crippling skeletal fluorosis. These are marked by "joint pains, calcification of ligaments, and arthritic complaints", all symptoms widely prevalent in fluoridated communities. Other effects of fluoride's toxic potentialities are becoming disturbingly clear, said the NRC report.

"Fluoride appears to have the potential to initiate or promote cancer," it said. It can damage the brain, too, with as yet unknown consequences. The report discussed the possibility that fluorides act to increase the risk of developing Alzheimer's disease.

The NRC's call for more research has been ignored by fluoridating countries, including the US. The report has been dismissed as irrelevant in Ireland. "There is no scientific evidence that water fluoridation causes any ill medical effects," the Department of Health told The Sunday Business Post.

However, the Department refuses to do its own research to back this statement up, despite the 1960s Health Act stipulating this take place. When asked why no general health research has been done in 50 years, the department said it "uses information from across the globe in order to assess the health impact of water fluoridation".

According to the NRC's Dr Hardy Limeback: "The evidence has convinced me that the benefits of water fluoridation no longer outweigh the risk [of fluoridation]."


Death knell

An expert committee set up in 2000 by the then health minister, Micheál Martin, to look into water fluoridation found no evidence of fluoride's toxic effects when it reported in 2002.

The forum's findings contrasted sharply with that of a Belgian Health Ministry report, published weeks previously. It found that ingesting fluoride causes osteoporosis and neurological disorders. "Fluoride is a slithering poison, it slowly creeps into the brain," said the then Belgian health minister Magda Aelvoet, as she announced a ban on fluoride supplements in July 2002.

The Irish Department of Health's forum did, however, admit that we are getting too much fluoride. It recommended turning our fluoride taps down from 1ppm, to a safer 0.8ppm.

The forum also looked at the issue of having babies drink infant formula made from fluoridated tap water. Firstly, babies don't need any fluoride - they have no teeth. But as they drink three to four times more liquid than adults, relative to their size, they get three to four times fluoride's toxic effects. Also, babies can't excrete fluoride, so 90 per cent of it stays in their body. With one of the lowest breastfeeding rates in the world, this is a uniquely Irish public health concern.

An independent report submitted to the forum on the topic should have sounded the death knell for fluoridation.

"The Scientific Committee agrees that the precautionary principle should apply and recommends that infant formula SHOULD NOT be reconstituted with fluoridated tap water," said the report by the Food Safety Association of Ireland (FSAI). Irish newborns are getting "up to seven times the safe dose," it claimed. However, the recommendations were excised in the forum's final report.

Dr Don MacAuley, spokesman for Irish Dentists Opposing Fluoridation, believes the forum buried the Food Safety Authority's damning risk assessment. An Oireachtas Health Committee hearing on the issue in July 2003 yielded no clear answers on what happened. However, forum members admitted that the original FSAI finding spelled the beginning of the end.

"It probably would have meant an end to water fluoridation, or at least a serious reappraisal of it," Dr Joe Mullen told the Dáil committee. "If further evidence emerged that this was a problem, it would be a very serious blow for water fluoridation."
Further evidence has now emerged. In 2006, the National Research Council concluded that babies fed infant formula made from fluoridated water, are exceeding safe intake levels. In response, numerous US public health authorities, including the American Dental Association, advised that tap water should not be used to reconstitute infant formula.

In 2011, the EC's SCHER report said that even at Ireland's new lower fluoride level of 0.8ppm, Irish children, who are also regular users of toothpaste, are being exposed to unsafe fluoride levels in tap water. "For younger children (1-6 years of age), the upper tolerable intake level (UL) was exceeded when consuming more than 1L of water at 0.8 mg fluoride/L (mandatory fluoridation level in Ireland)," said the SCHER report.

It also reaffirmed that formula-fed babies in Ireland were exceeding the safe dose, as set by the US Institute of Medicine. "For infants up to six months old receiving infant formula . . . this amount is 200 times higher than the amount found in breast milk," said the SCHER report.
By its own admission, this evidence that fluoridation gives our most vulnerable citizens unsafe levels of fluoride every day should be enough for the Department of Health to stop water fluoridation. Instead, its fluoride promotion unit, the Expert Body on Fluorides and Health, maintains that fluoridated water is still "safe for use in preparing infant formula".

When asked why it has not issued advice to parents as per the US, the Department of Health, which accepts that fluoride works topically, on the tooth surface, and that new-born babies have no teeth, states that "all ages benefit from fluoridation".
It also claims that the controversy on infant formula is based on "inaccuracies and scientifically unfounded connections". It doesn't outline what these might be.


Public health versus public health policy

According to the Irish Dental Association: "The introduction of water charges is sure to provoke interesting debate surrounding water fluoridation." The dentists' representative body describes fluoridation as "the most practical, cost-effective and safe public health measure to control the occurrence of tooth decay in Ireland".

Unfortunately, the Irish public doesn't share its enthusiasm. According to a Dental Health Foundation survey, more than two-thirds of adults are "concerned about fluoride in their water". Almost a quarter are "very concerned", and nearly 90 per cent of submissions to the Forum on Fluoridation were from citizens against it.

Yet no political party has ever represented the electorates' views on the issue. Both government parties, Fine Gael and Labour, questioned fluoridation in opposition, but today seem in no mood to rock the boat. Meanwhile, Labour's Alex White, the junior health minister, has been actively defending the practice.

With Micheál Martin - who ratified its continuation in 2002 - now leader of Fianna Fáil, a challenge to the status quo has been left to Sinn Féin. The party's environmental spokesman, Brian Stanley TD, recently published a bill to repeal the 1960 Health Act. "This is not a party political issue, but an issue of public health. I will be seeking cross party support for this bill when we debate it in the Dáil," says Stanley.

Others are also actively campaigning for its cessation. Tralee native Aisling Fitzgibbons is planning a High Court case against the state later this year, to try to ban the measure. Environmental scientist Declan Waugh has produced research showing that Ireland tops the league table on many ill effects linked with fluoride ingestion, including cancer and neurological disorders.

Journalist Iva Pocock has recently asked the EU Petitions committee to declare hydrofluosilicic acid in breach of the EU's Medicinal Products Directive.

Irish Water, the new semi-state, will install 27,000 water meters a month between now and the end of 2016. As it does, it will be acutely aware of the absurdity of dispensing medicine through a public utility; 99.9 per cent of the Department of Health's precious fluoridated water is either lost in underground leaks, used by industry or flushed straight down the national drains as domestic waste. Virtually all of it bypasses our teeth. Stopping fluoridation today would save the state €4 million a year.

Studies from Finland, former East Germany, Cuba and British Columbia have shown no increase in decay rates in teeth after cessation of water fluoridation. In fact, if anything, tooth decay continued to fall after it was stopped. "The few studies of water fluoridation discontinuation do not suggest significant increases in dental caries," said the European Commission's SCHER report in 2011.

Here in Ireland, this doesn't leave us with much to smile about.

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