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. wants to get rid of fluoride in our tap water. The initiative is controversial.
Those in favor argue that the evidence of harm is compelling: fluoride impacts cognitive development, disrupts the endocrine system, and causes harmful bone abnormalities, and it does all this at levels considered “safe” by the EPA and WHO.
Those against maintain that fluoride is safe and effective. They deem the existing evidence insufficient. They claim 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.
People have been arguing about fluoride for a long time. And for a long time, being anti-fluoride would make you a wacko flat-earther conspiracy theorist in the eyes of the average MSNBC consumer.
But the overton window is shifting. This September, the DC advocacy group Food and Water Watch sued the EPA in federal court over negligent fluoride policy and won. Judge Edward Chen delivered the ruling, stating that the evidence for fluoride harming cognitive development was compelling, and the EPA was obliged to take action, either by removing fluoride from our tap water or proving its safety beyond reasonable doubt.
Looking deeper into the issue, I was also surprised to see many thousands of scientists, researchers, and health officials who have been speaking out against fluoride for a long time. Many of them are quite clouted. We’re talking:
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
It’d be hard to dismiss these guys as conspiracy nuts.
Another interesting point for the anti-fluoride stance is that many wealthy countries like Denmark, Germany, and Finland— countries with better public health programs than the US, with more than enough budget to fluoridate their tap water— choose not to. Why not? The CDC named fluoride as one of the greatest public health achievements of this century! So, if fluoride is safe, cheap, and immensely effective, why wouldn’t Denmark get on board? Are they conspiracy nuts? Probably not.
Now for the pro-fluoride point. There is evidence fluoridated water reduces cavities. But the effect size is still unclear. For example, a study in England estimated fluoridated water led to 3 to 11% absolute reduction in tooth decay in children. But 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, suggesting that diet and lifestyle changes have decreased the need for fluoride. You may have also heard of the “Calgary study”, often referenced by establishment-friendly media outlets, but I found it problematic for reasons Chris Neurath lists here.
So, fluoride seemed to help our teeth a lot in the past. It probably protects are teeth a bit now. Let’s look at the risks more rigorously so we can make a good decision.
There are hundreds of studies on the potential harms of fluoride in humans, and there are numerous reviews of these studies.
The biggest review came out of the US National Toxicology Program, a department of the HHS, in 2019. Their SYSTEMATIC REVIEW OF FLUORIDE EXPOSURE AND NEURODEVELOPMENTAL AND COGNITIVE HEALTH EFFECTS, concluded that fluoride at the concentrations added to our tap water is a “cognitive neurodevelopmental hazard to humans”. This was startling, because the CDC, the American Dental Association, and the American Academy of Pediatrics were all extremely confident that fluoride was totally safe and effective. They dismissed— and continue to dismiss— all dissent as bad science.
Since the NTP’s conclusion was so shocking to the CDC, the National Academy stepped in to peer review. And, after five whole years of back and forth, the NTP released a revised monograph in August of this year. Their updated conclusion was this: water fluoride concentrations above 1.5mg/L are 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.
With the revised conclusion, the powers-at-be were appeased. The majority of us are not getting over 1.5mg/L of fluoride in our water (2.9 million of us are, but it’s often due to natural contamination rather than government fluoridation). But many activists were left wondering: were they bullied into the revision? The science still seems to suggest toxicity at levels under 1.5mg/L! You can find a thorough breakdown of the NTP review here.
So, who should we trust? The thousands of dentists, researchers, prime ministers, government health officials, who say fluoride is harmful? Or the thousands of dentists, researchers, prime ministers, and government health officials who say that say its safe? Was the NTP biased? Or is it the ADA?
Because scientific discourse is such a mess these days, we have to get a bit clever with our decision making. Maybe we can look at the potential mechanism of fluoride toxicity to see how sus it is.
Here’s a crash course on the average dentist’s view of the physiology of fluoride:
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 we ingest flouride, fluoride ions react with these natural hydroxyapatite crystals, turning some of them into fluoroapatite
Fluoroapatite is “harder” (bonds are more resistant to acid) than hydroxyapatite, and so our fluoridated teeth are more resistant to tooth decay. This makes dentists happy
However, what many dentists don’t consider is that hydroxyapatite does not just make up our teeth and bones. It also makes up our pineal gland! And it does this at much higher concentrations than our teeth or bones.
So, the fluoride we drink should also be turning our pineal gland hydroxyapatite to fluorapatite. It’s making our pineal gland harder. What’s the effect this? We really have little idea. But early research suggests it may interfere with melatonin synthesis.
This is an excerpt from a 2019 fluoride study at the Icahn School of Medicine at Mount Sinai:
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.
And again, we find the US government itself validating the potential harms of fluoride!
Actually, that whole 2019 study is wild. The study looked at the impact of fluoride at “safe”, everyday, concentrations on sleep disturbances in teenagers. Why sleep disturbances? Because the pineal gland helps regulate sleep, and fluoride might disturb the pineal gland.
The study concluded 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 could 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 is solid evidence for the fluoride-pineal gland link!
Also, the pineal gland has many critical functions beyond regulating sleep. So if flouride disturbs the pineal gland, then it’s disturbing all kinds of big things: immunity, mood, puberty, etc.
This 2019 study is especially useful because:
it looked at fluoride concentrations at levels deemed safe by our government
it measured sleep and wake time, which much less controversial than measuring IQ
it was motivated 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 discussed 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.
At the end of the talk she advises people to avoid fluoridated water.
So, if many epidimeologists are saying that fluoridated water is probably bad, should we really be forcing it onto everyone?
Do we really want to wait for a billion more studies? Just to be ultra-sure?
No! That’s the same mistake we made with leaded gasoline, which ended up poisoning millions before we finally banned it. And besides, we can address oral health in other ways! The three countries I mentioned before, Denmark, Germany, and Finland, who don’t fluoridate their water, also happen to have the the healthiest teeth2 in the world! Is it just genetics? No, because Australian Aboriginals also had perfect teeth until they were introduced to white sugar and refined flour. Healthy teeth should be addressed with diet. And fluoride tablets, which are ultra cheap, can always be given out for free as needed. We should not be poisoning the entire water supply for .24 less cavities per person.
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.
Update from March 2025: I just saw that in 2021, the fluoride sleep study partially replicated in a Canadian population.
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.
Measured by lowest DMFT index (Decayed, Missing, and Filled Teeth)