In this series, we explore the contentious findings surrounding fluoridation of the U.S. public water supply and answer the question of whether water fluoridation poses a risk and what we should do about it.
Previously: Recent multi-year NIH-funded studies found fluoride exposure was linked to reduced IQ and ADHD in children, bringing up more concern around individual exposure and dosage.
Our exposure to fluoride doesn’t just come from fluoridated water. This makes it difficult to determine how much fluoride people are actually consuming. Then there is the added challenge of figuring out how much is actually safe, given how differently people respond to this chemical.
Fluorine is a diatomic gas and the most reactive and electronegative of all the elements. Fluoride is any combination of elements containing the fluorine atom in the -1 oxidation state, per the National Library of Medicine compound summary.
Fluorides can be inhaled, ingested, or absorbed through our skin. That means there are several factors that determine what your daily dose of fluoride is and what amount may be accumulating in your body.
According to the National Research Council’s (NRC) 2006 scientific review of fluoride in drinking water, we ingest fluoride in our food, water, beverages, fluoride-containing dental products, pharmaceuticals, and pesticide residue. There are also various fluorides in the air and soil from natural sources such as volcanic eruptions and weathering of crustal rock as well as from toxic man-made industrial chemical emissions and cigarette smoke.
After the 2006 NRC committee’s extensive review, they noted gaps in the information around fluoride that prevented them from making judgments about the safety or the risks of maximum fluoride at levels permitted in drinking water.
The current maximum containment level goal (MCLG) is 4 milligrams per liter (mg/L). If average levels exceed 2 mg/L, the public is supposed to be notified.
The Commissioned Corps of the U.S. Public Health Service currently recommends a concentration water fluoridation level of 0.7mg/L.
Authorities are aware of the need to figure out how much fluoride people are actually exposed to given that the NRC committee highlighted the lack of exposure assessments in their 2006 review. It also highlighted the fact that some people are more vulnerable to fluoride overdoses than others.
Dose and Upper Limits
The fluoride dose depends on how much you get from all sources such as water, tea, food, dental products, air, and pesticide residue. A dosage depends on body weight, so one set dose is far more significant for a child than an adult.
And unlike drugs, our daily doses of fluoride come from multiple sources and isn’t easily quantifiable, even with all the oversight of community water fluoride programs by government agencies. The more thirsty you are, the higher the dose you get and certain habits can also lead to higher doses.
In 1997, the U.S. Food and Nutrition Board (FNB) of the Institute of Medicine (IOM) established a tolerable upper intake level (UL) for fluoride.
A UL is the maximum intake amount that is unlikely to pose any potential harm to the health of almost all individuals in the general population.
Below are the current ULs for fluoride for the prevention of moderate dental fluorosis and skeletal fluorosis:
- Zero–6 months: 0.7 mg/day
- 7–12 months 0.9 mg/day
- 1–3 years: 1.3 mg/day
- 4–8 years: 2.2 mg/day
- 9 and over: 10 mg/day
The EPA’s 2010 “Fluoride: Dose-Response Analysis For Non-Cancer Effects” clarifies that for fluoride, the UL is based solely on the prevention of moderate dental fluorosis for children up to 8 years old, and for all other age groups, the UL is based on the prevention of skeletal fluorosis. Other diseases, including the neurodevelopmental risks mentioned in the previous article in this series aren’t factored in.
The Epoch Times reached out to the Environmental Protection Agency (EPA) with questions on studies that conclude fluoride can affect IQ in children and asked for additional information on tolerable upper fluoride intake levels for neurotoxic effects.
The EPA responded that they are “currently reviewing the National Primary Drinking Water Regulation (NPDWR) for fluoride under the fourth Six Year Review.”
“As a part of this review, EPA will be considering the best available information, science, and data prior to deciding whether or not to update the fluoride NPWDR. EPA will be reviewing the draft report released by the National Toxicology Program (NTP) and looks forward to considering the final report when it is available,” a spokesperson for the EPA stated.
The NTP report was performed by an external review board and has been a source of controversy in an ongoing lawsuit against the EPA as internal CDC emails obtained through the Freedom of Information Act showed government agencies interfered with its release.
The report draft was finally made public on March 15 under an agreement reached in the ongoing lawsuit.
Exposure and Susceptible Subpopulations
When it comes to fluoride exposure and its consequences, one of the government-accepted reviews comes from scientists from the Agency for Toxic Substances and Disease Registry (ATSDR).
In 2003, the ATSDR prepared the “Toxicological Profile For Fluorides, Hydrogen Fluoride, and Fluorine” report in accordance with the EPA and had it peer-reviewed by CDC staff and other federal scientists.
The ASTDR report identified subpopulations susceptible to fluoride exposure as those who “exhibit a different or enhanced response to fluorides, hydrogen fluoride, and fluorine than will most persons exposed to the same level of fluorides, hydrogen fluoride, and fluorine in the environment.”
These subpopulations include those with kidney problems; deficiencies of calcium, magnesium, vitamin C, or protein; the elderly, and those with osteoporosis.
The NRC report states that there are also subgroups of people that may consume greater amounts of water, which results in higher exposure to fluoride such as pregnant or lactating women, infants, those with high activity levels (military personnel, athletes, manual laborers), people with health conditions that affect water intake such as diabetes mellitus or diabetes insipidus, and people living in very hot or dry climates.
The report highlights that some adults in the U.S. population could have community water intakes as high as 80 mL/kg per day and some infants could exceed 200 mL/kg per day.
The researchers stress that intake assessments weren’t made for susceptible subpopulations, those who consume significantly more fluoridated water, or children who could have fluoride intakes from dental products that exceed the dietary intakes.
Additionally, they also express concerns about all the other fluoride the population is taking in from multiple sources beyond drinking water and the need to fully understand total fluoride exposure from all sources combined.
Fluoride in the Environment
According to the Toxic Release Inventory (TRI), in 2021, the total release of hydrogen fluoride to the environment (including air, water, and soil) from 638 reporting facilities was 388.8 million pounds. However, the ASTDR report cautions that the TRI data isn’t an exhaustive list and only certain types of facilities are required to report.
The 2003 ATSDR report list sources of man-made airborne fluoride as aluminum production plants, phosphate fertilizer plants, nuclear industries, steel mills, coal combustion plants, chemical production facilities, magnesium plants, manufacturers of brick and structural clay, and electrical utilities.
They note that electric utilities are the greatest contributor at 78 percent of total environmental fluoride released.
Airborne fluoride emissions end up in the soil and surface water in addition to the naturally occurring fluorides and the chemical fluorides added to the public water supply. (As discussed in a previous article in this series, those fluoride additives are also derived from industry emissions.)
The 2006 NRC report cautions that in addition to being taken up by and accumulated in food sources, “fluoride in soil could be a source of inadvertent ingestion exposure, primarily for children.”
The ATSDR report notes that concentrations of fluoride in the air, water, and soil can range from low to very high depending on mineral deposits, airborne deposits released from industrial operations, the use of phosphate fertilizers, or areas close to hazardous waste sites.
Food and Beverages
According to the 2006 NRC report, foods and other consumed beverages that are most notable for their high fluoride content are teas, processed chicken, infant formula, grapes and grape products, commercial beverages such as juice and soft drinks, beer, soups, canned fish, cooked wheat cereal, and some kinds of seafood.
Both the NRC and the ASTDR reports note that fluoride levels in foods and beverages greatly depend on the fluoride content of the water used in their preparation and manufacturing as well as the fluoride concentration in the soil they are grown in.
Per the NRC, the high fluoride content in grape products is due to the use of pesticides, particularly cryolite, while mechanical deboning of chicken that leaves skin and residual bone particles in the meat contributes to its high fluoride content.
Seafood such as mussels and shrimp can accumulate fluoride if they are located in estuaries where aluminum plant waste is released. Tea is known to accumulate a substantial amount of fluoride from soil and fluoride dust in the air with 97 percent accumulating in the plant’s leaves.
The NRC report cited research that found fluoride concentrations of 1.0–6.5 mg/L in both caffeinated and decaffeinated commercial teas obtained in St. Louis.
Another study it cited looked into fluoride concentrations in a variety of juices in the United States and found fluoride concentrations from 0.15 to 6.80 mg/L.
Bottled water can also contain more fluoride than declared on the label with concentrations found as high as 1.36 mg/L notes the report. Distilled and reverse osmosis water have very low concentrations of fluoride, however.
Bottled water can also contain more fluoride than declared on the label with concentrations found as high as 1.36 mg/L notes the report. Distilled and reverse osmosis water have very low concentrations of fluoride, however.
Pesticides and Pharmaceuticals
According to the NRC report, fluorine-containing pesticides and pharmaceuticals also contribute to total fluorine exposure.
Cryolite and sulfuryl fluoride are two pesticides mentioned in the report that are monitored and regulated due to their potential to contribute to inorganic fluoride residues in foods that are currently used on many fruit, vegetable, and feed crops.
Many pharmaceuticals also contain fluoride.
An April study published in the International Journal of Molecular Sciences states that “to date, more than 300 fluorinated pharmaceuticals have been approved for use as drugs.”
The study reports that since the introduction of fluorocorticosteroid and fludrocortisone in 1954, 30 percent of fluorinated drugs on the market are “blockbuster pharmaceuticals,” such as Lipitor, Fluoxetine, Linezolid, or Fluticasone.
A great resource that maintains a database of all fluorinated pharmaceuticals is the Fluoride Toxicity Research Collaborative.
Dental Products
Authors of the ATSDR report warn that swallowing toothpaste can account for a large percentage of fluoride exposure for children under 8 years old.
The Food and Drug Administration requires a warning label on toothpaste for this reason.
A study cited in the report, (Levy 1993, 1994), warns that “some children probably get more than the recommended amount of fluoride from toothpaste alone, apart from food and beverages.”
Authors of the NRC report emphasize that numerous papers have suggested several recommendations to reduce the risk of excessive fluoride ingestion in children including, using very small amounts of toothpaste, rinsing and spitting after brushing, avoiding flavored toothpastes, discouraging the use of fluoride toothpaste in children under 2 years old, and supervision of young children during tooth brushing.
Christy A. Prais received her business degree from Florida International University. She is the founder and host of Discovering True Health, a YouTube channel and podcast dedicated to health and wellness. Prais also serves on the advisory board at the Fostering Care Healing School. She is a contributing journalist for The Epoch Times.