how much is enough?
Fifty-five years ago they told us that in order to have healthy teeth, we needed to have one part fluoride in each million parts of water. That’s the same as one milligram of fluoride per liter – about one-quarter milligram per 8-ounce cup.
According to the National Academy of Sciences (NAS/NRC), reduction in the average number of dental caries per child was nearly maximal in communities having water fluoride concentrations close to 1.0 mg/liter. This is how 1.0 mg/liter became the ‘optimal’ concentration. That is, it was associated with a high degree of protection against caries and a low prevalence of the milder forms of enamel fluorosis. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1999)
Under normal conditions of living, fluorine is a trace element in human nutrition (McClure, 1951). Minute amounts are absorbed from certain foods and drinking water and, to a limited extent, are retained by dental and osseous tissues. The quantity of fluorine ingested in food is a relatively unimportant variable; the average diet contains 0.2 to 0.3 mg. daily. Of greater import is the variable quantity ingested in drinking water. Report of the Ad Hoc Committee on the Fluoridation of Water Supplies, Division of Medical Sciences, National Research Council (Nov. 29, 1951)
|Total Daily Fluoride Intake, 1940s – McClure, 1 ppm areas|
McClure, Frank J., Ingestion of fluoride and dental caries –quantitative relations based on food and water requirements of children 1 to 12 years old, American Journal Diseases of Children (Vol 66, page 362, 1943)
In areas where fluoridation could not be implemented, tablets were available in 1/2 to 1 mg doses. These were equally effective, according to the professional dental literature of the day.
“Topical” effects are stressed today, rather than “systemic” effects, but the distinction is a moot point. Plaque fluoride concentrations are directly related to the fluoride concentrations in and frequencies of exposure to water, beverages, foods, and dental products. Fluoride can be deposited in plaque by direct uptake from these sources as well as from the saliva and gingival crevicular fluid after ingestion and absorption from the gastrointestinal tract. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1999)
According to NAS/NRC, Although the total amount of fluoride ingested daily by older children and adults is greater than by infants or young children, it is generally lower when expressed in terms of body weight. … average dietary fluoride intakes by adults living in fluoridated communities have ranged from 1.4 to 3.4 mg/day, or from 0.02 to 0.05 mg/kg/day for a 70 kg person. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1999)
The first figure (1.4 mg/day) represents fluoride exposure during the 1940s … the second figure (3.4 mg/day) represents the quantity of fluoride found in duplicate meals in hospital settings during the early 1970s. By 1981 the American Medical Association had published a pamphlet which indicated the total dosage was about 5 mg/day. In 1991 the U.S. Public Health Service published estimates ranging to 6.6 mg/day for a 50 kg adult living in an optimally fluoridated area.
Unfortunately, there is no current data on total daily intake in any U.S. city – other than dental fluorosis rates – which represent the effect of exposures beginning at least a decade earlier, rather than the current dosage from all sources. In other words, like the stars, what we see is but a reflection of the past. Dental fluorosis rates will always reflect what can be seen after the fact … almost a decade after it is too late for prevention.
In any case fluoride dosage has nothing to do with the concentration of fluoride in drinking water. It has everything to do with total dosage from a myriad of sources over a period of time. The dose is the poison – or the meat.
how much is too much?
In 1953, when Harold C. Hodge, chairman of the National Academy of Sciences toxicology committee, evaluated the dangers associated with excess fluoride, the best data available was Roholm’s classic, Fluorine Intoxication. Roholm had studied workers exposed to fluoride in dusts from aluminum ore. He reported that with an intake equal to 0.2 to 0.35 mg/kg/day, phase three skeletal fluorosis developed after about eleven years. In terms of milligrams per day, the equivalent is 10-20 mg/day for 10-20 years for persons weighing 100 to 229 pounds. As is generally true, toxicity depends on dosage per pound (or kilogram) of body weight. What wouldn’t faze a 220 pound man might kill a newborn infant. (See excerpts from Roholm here
According to the Surgeon General, fluoride accumulates in a linear manner. Eighty to one hundred percent of ingested fluoride is absorbed from foods and beverages. The fractional retention or balance of fluoride at any age depends on the quantitative features of absorption and excretion. For healthy, young, or middle-aged adults, approximately 50 percent of absorbed fluoride is retained by uptake in calcified tissues, and 50 percent is excreted in the urine. For young children, as much as 80 percent can be retained owing to increased uptake by the developing skeleton and teeth. Such data are not available for persons in the later years of life … Dietary Reference Intakes (1999) NAS/NRC
This does not mean that 50% of all ingested fluoride is retained forever. It means that a portion of each day’s fluoride intake will remain, a portion will be excreted, and a portion may simply pass through the system, never having been absorbed.
When the blood contains too little calcium, the parathyroid gland causes the release of calcium from bone. Fluoride released in this way will be circulating in the bloodstream until it is excreted or re-deposited – when calcium is once again plentiful.
In terms of balance, it is generally agreed that approximately one half of what goes in will stay in. Again, however, just as money in a bank can accumulate with repeated deposits, it will not necessarily be the actual bits of money which matter, but the balance. Individuals deposit and withdraw at different rates. With a full-blown case of crippling skeletal fluorosis the balance is generally thought to be such that one may cease making deposits altogether, continue to make small withdrawals, and still maintain a balance as much as twenty years later. This is what is meant by turnover of fluoride in the human skeleton.
So then, we can understand why NAS/NRC says, As the intake of fluoride is increased, either by increasing the dose or by increasing the time during which a constant amount of fluoride is ingested, the amount found in the bone also increases. … The long-term hazard to be protected against in the course of exposure to fluorides is the development of crippling fluorosis.
So, what’s the problem?
Well, dosage is the problem. By 1974 samples of duplicate meals were showing more than ten times as much fluoride as had been found thirty years earlier – from 0.2 to 0.3 mg/day to as much as 3.44 mg/day in a non-fluoridated area.
|Corvalis, OR||0.60 ppm||3.44 mg/day|
|Milwaukee, WI||0.85 ppm||3.41 mg/day|
|Cleveland, OH||1.27 ppm||3.05 mg/day|
|Tuscaloosa, AL||0.76 ppm||2.94 mg/day|
|Madison, WI||1.11 ppm||2.88 mg/day|
|Iron Mountain, MI||0.08 ppm||1.03 mg/day|
Dietary Fluoride In Different Areas in the United States, Kramer, Osis, Wiatrowski & Spencer, American Journal of Clinical Nutrition – 27:590-594, 1974.
The 3.44 mg/day figure, however, does not represent total daily intake. Between-meal snacks and beverages are not included. Just one cup of tea can contain more fluoride than a gallon of 1 ppm fluoridated water these days.
It is to be expected that over the years a non-degrading basic element such as fluorine would accumulate in the soil and in the leaves of plant life exposed to hydrogen fluoride in the air. Add to that the increased use of organic and inorganic fluoride pesticides and herbicides, which can leave residues on fruits and vegetables. Ground meats for processed foods, hot dogs, sausage, hamburger, etc., are removed from the bone by machines today. They contain fluoride-rich bone particles. Toothpastes and mouthwash with fluoride were not available during the 1940s. It all adds up. Fluoride is no different than lead or arsenic in that regard … very small quantities taken over a long period of time can have profound and lasting adverse effects. These effects can easily escape detection until it is too late, and the damage is irreversible.
In 1977 NAS/NRC commented that if the new estimates for dietary fluoride intake were accurate, there could be a serious problem. They said, Recent studies indicate that the total intake of fluoride is as high as 3 mg/day rather than the earlier figure of 1.5 mg/day, primarily because of increases in the estimated levels of fluoride in food. (1970) Balance data presented by Spencer also suggest a higher retention by bone, nearly 2 mg/day rather than the 0.2 mg/day indicated earlier. … These findings are important . . . a retention of 2 mg/day would mean that an average individual would experience skeletal fluorosis after 40 yr, based on an accumulation of 10,000 ppm fluoride in bone ash. [this is Roholm’s phase 3 Crippling Skeletal Fluorosis]
However, at that time, everyone else was still relying on the NAS/NRC expert who interpreted Roholm in the first place. Dr. Hodge had probably neglected to convert pounds to kilograms when he calculated a milligram per day figure for a typical range in body weight (100 – 229 pounds).
As a result, instead of realizing that 2 to 8 milligrams a day might produce the condition known as skeletal fluorosis over a lifetime, the dental and medical community were taught that in order to develop crippling skeletal fluorosis (CSF) one would have to ingest 20 to 80 mg/day for periods of ten to twenty years. The American Dental Association pamphlet, Fluoridation Facts used this erroneous 20-80 mg/day figure until their latest revision in 1999. EPA used the same figure in setting the maximum contaminant level for fluoride in drinking water, which is currently in force at 4 ppm … not allowing for exposure beyond twenty years, not considering vulnerable population groups such as those with kidney disease or diabetes, and not considering the arthritis and osteoporosis of phase two skeletal fluorosis to be an “adverse” health effect at all! Only phase 3 crippling skeletal fluorosis qualifies for the magic “adverse” effect status. EPA insiders describe the cover-up at EPA here.
According to the public health service, The daily intake of most adults is about equally divided among food, drinking water, beverages, and mouthwash. The table on page 17 of Review of Fluoride Benefits and Risks (1991) indicates that the current total daily intake of fluoride in optimally fluoridated areas has grown to a range exceeding 6.5 mg/day for a 50 kg man.
Obviously, if virtually all the fluoride in our diet was coming from water in 1945, but we are currently exposed to additional sources of fluoride not available sixty years ago, then we now get several times the optimum in an optimally fluoridated area, and somewhat more than the optimum in areas without the ‘benefit’ of water fluoridation.
According to Krishnamachari, in Trace Elements in Human and Animal Nutrition, the textbook edited by Walter Mertz for U.S.D.A., and used by NAS/NRC/IOM for their Recommended Dietary Allowances, Fluorine being a cumulative bone-seeking mineral, the resultant skeletal changes are progressive. According to the natural course of the disease, skeletal fluorosis may be classified into the following phases: preclinical, musculoskeletal, degenerative and destructive, crippling fluorosis, and complications. … effects depend not only on the total dosage and duration of exposure, but also on associated factors such as nutritional status, functional status of the renal tissue, and interaction with other trace elements. Since the effect of fluorine is cumulative, the less serious consequences occur early in the natural course of the disease. Whatever may be the type of fluorine exposure, the clinical picture in chronic poisoning occurs in a phased manner.
Pain is a cardinal feature due to arthritic lesions and to secondary peripheral nerve involvement. … workers at risk: aluminum smelters, phosphate fertilizer, ceramics, steel, glass industries.
Fluorine entering the body rapidly moves to the hard tissues. A fraction of the ingested fluorine is excreted daily. There is not only inter individual variation but also intra individual variation in respect to excretion, which depends on three factors (1) total fluorine intake; (2) duration of exposure to fluorine; and (3) normal kidney function. Adult males excrete more fluorine than females … on a community basis, urinary fluorine excretion may be a dependable indicator of community exposure.
It is thus clear that the clinical picture of fluorosis includes softening of the bones and osteoporosis as well as secondary hyperparathyroidism on a global basis.
In 1979 Hodge corrected his error regarding Roholm’s crippling intake figures. EPA didn’t notice. After a series of letters to and from NAS/NRC/IOM (Institute of Medicine), the official 20-80 mg/day figures were changed to 10 to 20 mg/day in 1993.
One milligram a day … even two milligrams a day over a lifetime … may produce few obvious adverse effects.
Multiply that figure by five or ten, and it’s an entirely different story.
Why isn’t anyone noticing, you ask. Where are the victims?
The answer is simple. No one really looked for them prior to 1945. No one has looked since.
In 1945 McClure wrote, Epidemiological studies of the non-dental effects of fluorine, as ingested in fluoride domestic waters, are extremely few in number and very limited in scope. Non Dental Physiological Effects of Trace Quantities of Fluorine, Journal American College of Dentists – 12:50, (1945)
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. Skeletal fluorosis is not even discussed in most medical texts under the effects of fluoride; indeed, a number of texts say the condition is almost nonexistent in the U.S. Even if a doctor is aware of the disease, the early stages are difficult to diagnose. Fluoridation of Water, Special report by Bette Hileman, Chemical & Engineering News, August 1, 1988 p 35-36
Other than Roholm’s work for the aluminum industry, there have been no long-term studies on the effects of fluoride on humans. All workplace and environmental regulations in the United States are based on Roholm’s findings. Unfortunately, the regulations are inadequate because they were calculated using Hodge’s erroneous 20-80 mg/day dosage figures.
Roholm’s estimates are the numerical equivalent of one milligram of fluoride daily for each fifty-five pounds of body weight for 55 to 96 years. The current range in fluoride intake exceeds 6 mg/day.
We know people are getting much more fluoride than is necessary to duplicate the optimum dosage of the 1940s. Sixty years ago about 10% of the children living in a 1 ppm area developed the very mildest forms of dental fluorosis – not visible except to the trained eye of a dental professional. Today the rate often exceeds 60%, with clearly visible effects that often require expensive cosmetic dental treatments.
We know that complaints of arthritic symptoms are more common than they were sixty years ago. Quite a number of troublesome health conditions seem to be more prevalent today. In earlier times, secretaries typed all day on manual typewriters without developing carpel tunnel syndrome. All of a sudden, body parts we used to take for granted seem to be wearing out before their time.
It isn’t because we live longer. A short visit to an old cemetary will show that more people may live past childhood today, but the length of life for man has not increased. The older the cemetary, the more likely it is that one will find headstones for people who lived well past the age of ninety, along with those who died in infancy or early childhood.
No one can say what causes any individual case of arthritis or fibromyalgia. There are no tests being used in the U.S. that are capable of determining how much fluoride any one individual has consumed over their lifetime. We know that 60 million people in India are suffering the effects of high-fluoride water from recently dug deep wells. That number represents a dramatic increase since 1970, when most wells in the endemic areas contained only 1 to 3 ppm fluoride, and the number of cases of skeletal fluorosis was said to be under 20 million.
As always, the dose is the poison.