The Great Fluoride Debate

RFK Jr. wants to remove fluoride from America's tap water. The CDC and ADA say fluoride is safe and effective. Who is right?

RFK Jr., Trump’s incoming HHS secretary, wants to get rid of fluoride in our tap water. The initiative is controversial.

Proponents of removing fluoride from drinking water argue that the evidence of harm is compelling. They claim fluoride impacts cognitive development, disrupts the endocrine system, and causes harmful bone abnormalities, even at levels considered “safe” by the EPA and WHO.

Defenders of fluoridation maintain that fluoride is safe and effective, warning that removing it from drinking water would lead to a significant increase in dental cavities in children.

Who's right? Let's take a look.

First, to dismiss anti-fluoridation as a fringe conspiracy theory or a “bizarre” idea (see MSNBC) is extreme.

In September of this year, DC advocacy group Food and Water took the EPA to court on the fluoride issue and won. Federal judge Edward Chen ruled in their favor, stating that the evidence for fluoride harming cognitive development is compelling, and the EPA is obliged to take action— either by removing fluoride from the water, or proving its safety beyond a doubt.

Also, among the thousands of scientists, researchers, and health officials have been speaking out against fluoride for many years, we find others who are quite hard to wave away:

• Dr. William Marcus, former chief toxicologist of the EPA Water Division.¹

• Dr. Magda Aelvoet, Belgium’s former Minister of Public Health

• Doug Everingham, Australia’s former Federal Health Minister

• Dr. Linda Birnbaum, former director of the NIH and the NTP

These are not people that you can easily dismiss as conspiracy theorists.

Also, many countries, like Denmark, Germany, and Finland, who are fully capable of fluoridating their water, do not. Why? The CDC says fluoride one of the greatest public health achievements of this century. So, if fluoride is a safe, cheap, and immensely effective intervention, why wouldn’t these countries get on board? Surely the case is not so clear-cut.

Second, I’d like to acknowledge that there is evidence fluoridated water reduces cavities. But the question of how much is still unclear. For example, a study in England estimated fluoridated water led to 3 to 11% absolute reduction in tooth decay in children. A review by Cochrane found that in studies before 1975, there was a reduction in cavities of about 2.1 per child. But in studies after 1975, the number dropped to .24— a possible interpretation being that diet and lifestyle changes have decreased the need for fluoride.

So, now, what are the risks of fluoride? There are hundreds of studies on the potential harms of fluoride in humans, and there are numerous reviews of these studies. The flagship fluoride review comes out of the US National Toxicology Program, a department of the HHS. They’ve been studying the fluoride literature for eight years.

In 2019, the NTP concluded that fluoride at concentrations added to our water is a “cognitive neurodevelopmental hazard to humans”. This was a startling conclusion, because the CDC, American Dental Association, and the American Academy of Pediatrics were extremely confident that fluoride was totally safe and effective. They dismissed any dissent by researchers as psuedo-scientific.

Because the conclusion was so surprising, and came out of the government’s own toxicology department, the 2019 monograph was put under rigorous peer reviewing by the National Academy². And, after five years of back and forth, the NTP finally released their revised monograph in August of this year. Their updated conclusion was this: water fluoride concentrations above 1.5mg/L is probably harmful, but concentrations below 1.5mg/L need further investigation.

For reference, California's legal limit on fluoride in water is 2mg/L, and the target range is .6mg/L to 1.2mg/L. The EPA’s recommended concentration is .7mg/L.

So, the government bodies were appeased, because the majority of us are not getting over 1.5mg/L of fluoride in our water (2.9 million are, but it’s often due to natural contamination rather than artificial). The ADA went further with a damning criticism of the NTP report, saying:

“After the [National Academies of Sciences, Engineering and Medicine] committee reported the first two drafts would not survive scientific scrutiny without major revision, [the National Toxicology Program] abandoned that course of peer review and, instead, hand-picked its own panel to review the draft before you,” Dr. Pollick testified during a May 4, 2023, panel hearing. “[The National Toxicology Program] also has not resolved what [the National Academies of Sciences, Engineering and Medicine] identified as ‘worrisome inconsistencies’ in its risk-of-bias determinations.”

So, who should we trust? The thousands of dentists, researchers, prime ministers, government health officials, who say fluoride is harmful? Or all those who say that say its safe? Is the NTP biased? Or is it the ADA?

Well, we know the government is usually slow to address hazards in our food and drug supply (e.g. DDT, trans fats, BPA), often due to corruption and lobbying.

And, in my opinion, we should be suspicious of any dentist who confidently claims that “fluoride is safe and effective”, when there is not enough evidence to prove this safety. The absence of evidence is not the evidence of absence, and they are relying on an absence of evidence to support their claim.

Maybe we can look at a fluoride study ourselves, to see how it reads.

I’d like to highlight a 2019 study on fluoride and sleep disturbances, done by researchers at the Icahn School of Medicine at Mount Sinai. The study concluded that concentrations of fluoride in our tap water deemed safe by our government's standards can cause serious sleep disturbances in teenagers. Specifically, they observed that a .52mg/L increase in water fluoride concentration, is linked to 1.97x greater odds of "self-reported snorting, gasping, or stopping breathing while asleep ever as compared to never." So, basically, normal concentrations of fluoride can give a healthy teenager sleep apnea.

Also, this same .52mg/L increase in fluoride concentration was linked to delayed bed and wake times, by twenty-four and twenty-six minutes respectively). This suggests fluoride may affect the circadian rhythm. And since the pineal gland is a key regulator of the circadian rhythm, it suggests that the fluoride in our water, as per the author's hypothesis, is interfering with one of the most critical parts of our body!

For decades, "experts", "fact checkers", and "debunkers", have treated the idea that fluoride disturbs the pineal gland as some hippie new-age conspiracy. But the scientific mechanism by which fluoride affects the pineal gland is absolutely clear.

The Icahn researchers summarize this mechanism in the background section of their paper:

Fluoride accumulation in pineal gland hydroxyapatite is present in higher concentrations than in any other part of the body, including bones and teeth. In 2006, a National Research Council report concluded that fluoride is likely to affect pineal gland function and cause decreased melatonin production which could contribute to a variety of effects in humans.

For those who are unfamiliar with hydroxyapatite:

• Hydroxyapatite is an important mineral in our bones and teeth. It makes up 65 to 70% of our bones and 80% of our teeth by weight.

• When flouride ions come close to these natural hydroxyapatite crystal, some of the hydroxyapatite molecules react with the fluoride to turn into fluoroapatite.

• Fluoroapatite is more resistant to acid than hydroxyapatite, and so teeth with more fluoroapatite are more resistant to tooth decay.

In summary: more fluoride consumption -> more fluoride in teeth -> more hydroxyapatite gets turned into fluoroapatite -> teeth are more resistant to acid and decay

But, hydroxyapatite is not only present in our teeth and bones— it’s also in our pineal gland. And its in our pineal gland at much higher concentrations than in our bones and teeth!

So, the fluoride we drink should also be turning our pineal gland hydroxyapatite to fluorapatite. What’s the effect this? We really have little idea. But early research suggests it may interfere with melatonin synthesis. And this hypothesis is supported by the sleep study.

And the pineal gland has many critical functions beyond regulating sleep. So if flouride can disturb the pineal gland, then it would be disturbing many important mechanisms in the body, such as immunity, mood, and the timing of puberty.

Like I said earlier, there are hundreds of studies on the risks of fluoride. But I chose to highlight this one, because:

• it looked at fluoride concentrations at levels deemed safe by our government

• measuring sleep and wake time is much less controversial than measuring IQ, and there are fewer confounding factors.

• there’s a promising theoretical mechanism for how fluoride could disturb sleep— accumulation in the pineal gland

More studies showing the harm of fluoride at lower levels have been reviewed and presented by epidemiologist Dr. Ashley J Malin in this presentation to the University of Michigan’s school of public health. Malin noted that some of the studies in her presentation were not included in the NTP review because of how recent they are.

There’s a Q&A at the end of the talk, moderated by Dr. Sung Kyun Park, an assistant professor of epidemiology at the U of M. One student asks:

Why is the CDC recommended fluoride level still .7mg per liter if there have been numerous studies showing that even moderate levels of fluoride are dangerous to children?

And Malin replies:

I think they can only answer that.

She goes on to clearly say she advises people to not drink fluoridated water.

So, if many experts are saying that fluoridated water is probably bad, should we forcing it onto everyone? Just because it hasn’t yet been proven harmful beyond all scientific skepticism?

We can address oral health in other ways. The three countries I mentioned before, Denmark, Germany, and Finland, who do not fluoridate their water, also have the the healthiest teeth³ in the world! Is it just genetics? Probably not, because Australian Aboriginals also had perfect teeth until being introduced to white sugar and refined flour. There are many other variables we can address if our goal is a country with healthy teeth.

Also, there is always a section of the population that will be hypersensitive to a certain chemicals. Fluoride allergy is already a known phenomena. Extreme cases are documented, but of course sensitivity is a spectrum. The NTP also notes in their monograph that:

A few studies also support the hypothesis that individuals with certain genetic variants in dopamine receptor D2 or catechol-O-methyltransferase may be at heightened sensitivities to the potential detrimental cognitive effects of fluoride exposure (Cui et al. 2018; Zhang et al. 2015b), potentially impacting dopamine catabolism and receptor sensitivity. Given the growing body of evidence suggesting an inverse association between estimated total fluoride intake and certain neurodevelopmental effects in children, differential exposures to total fluoride intake and genetic susceptibilities of children to fluoride may represent special situations that would appear to warrant further research.

And so while you and I might not have our lives ruined by fluoridated tap water, we must empathize with the fluoride sensitive among who are likely suffering from rashes, cognitive disorders, sleep disorders, arthritis, or thyroid dysfunction, caused in part by water fluoridation.

And for the rest of us who are not sensitive to fluoride per se, but may be suffering from some inexplicable chronic illness, or just feeling like we're not as healthy as we should be, fluoride may be one thorn in the hairy bush of industrial chemicals and pollutants contributing to our country's health crisis.

I pray that we can illuminate and uproot these potential causes one by one, so that our country may finally heal.

1. The case of Dr. Marcus is fascinating and infuriating. He exposed corruption and malpractice within the EPA, and was fired and then harassed for it.

2. Source

3. Measured by lowest DMFT index (Decayed, Missing, and Filled Teeth)