Yeah I mean what's the problem with just swishing some fluoride every once in a while. They used to bring it to us in school and ironically told us NOT to swallow it.
The problem is that a lot of people (a truly shocking number) won’t do that, and can’t be forced to (nobody wants the Toothpaste Gestapo). Without public health programs for things like fluoridation or vaccination, small slices of the population become disproportionate sinks of public health resources.
(You were told not to swallow the fluoride in school because it’s significantly more concentrated than contents in the water supply. The dose makes the medicine and the poison.)
I don’t think fluoride is considered a ”chronic” toxin at the levels found in municipal US water supplies. As noted elsewhere, these levels are pretty close to (and sometimes significantly below) natural fluoride groundwater levels elsewhere in the world.
(Saying that fluoride accumulates profoundly misses the point: it is supposed to accumulate. What fluoride doesn’t do is accumulate in soft tissues, which is why acute exposures to high doses of fluoride don’t guarantee intellectual forestallment like lead frequently does.)
First of all just because a water source is natural doesn't make it safe. Sea water, sulfonate rich springs, etc are bad for drinking.
That there are places around the world that have high with F doesn't make it safe. There are places in the world that had catastrophically high rates of cretinism. Turns out it was a natural factor in an otherwise idyllic natural setting.
I am aware that fluorine is supposed to accumulate in your teeth and doesnt in "soft" tissue; but it also accumulates in your bones and anywhere there is calcium.
Bones and teeth are not dead scaffolding, but an integral part of your body's biochemical system. I should know - they gnawed a hole into my hip to get at my marrow.
I’m not talking about mineral springs, or chugging a glass of seawater. I’m talking about the groundwater for much of continental Europe.
Again: it’s supposed to bioaccumulate there. Bioaccumulation is a part of homeostasis; the fact that iron (calcium, etc.) bioaccumulates is neither a reason to avoid it nor to exceed a healthy dietary quantity. And the evidence is overwhelmingly supportive of municipal fluoride levels being both safe and sufficient for dental health.
People aren’t recommended to drink 8 glasses or more of green tea per day and most people don’t have any.
The whole thing with fluoridated water is that whilst small doses may be harmless for most people, the more you consume the worse it is, and plenty of people - based on official recommendations - drink a lot of tap water each day.
Except if you drink the daily recommended amount of water, you don't come anywhere close to the fluoride in 1 cup of green tea. It's just a completely delusional panic.
What figures can you point to on mg/L of fluoride in (commonly consumed) green tea vs tap water?
Even aside from that, it’s a specious argument: people who want to avoid fluoride can just avoid green tea; it’s much harder to avoid it in tap water.
As for “delusional panic”: it matters a lot for iodine absorption and thyroid function for some people, which is a both widespread and overlooked/diminished, at great harm and cost to those who are affected and unable to get help.
For what it’s worth I’m not advocating for removal of fluoride from tap water, but there does need to be more recognition of the harms to those affected and serious efforts made to develop treatment approaches for those with iodine deficiencies and thyroid dysfunction, as it really is a catastrophic problem for a lot of people.
> What figures can you point to on mg/L of fluoride in (commonly consumed) green tea vs tap water?
Municipal tap water in the US is fluoridated between 0.7mg/L and 1.2mg/L, per the CDC's 1962 guidelines[1]. To my knowledge, most municipalities choose the lower end of that range (since the effects are diminishing and, well, it's cheaper).
By contrast, at least one survey of black tea infusions finds an average of 2.65mg/L[2]. So over twice the CDC's highest baseline for municipal fluoridation.
(Note: at that average for black tea, an adult would still need to drink ~4L of black tea a day to pass the CDC's tolerable upper limit. People grossly overestimate both how much fluoride is dangerous, and how much they actually consume.)
the argumen is much stronger for green tea. depending on time of harvesting and grow conditions, it has a lot more fluoride than black tea. this study found 7mg/L:
People go entire lifetimes not wearing seatbelts and die to old age rather than car crashes. This doesn't change the fact that fewer people die in car crashes when they wear seatbelts.
Your relationship with cavities doesn't change anything about the statistics of cavities with and without flouride in people's diet.
Wait... Is your mouth cavity free, or did you get your first one 7 years ago?
I was merely pointing out that your anecdote is already part of the statistical evidence and not particularly useful to a discussion of whether it should be added to water
"I don't want it in my water" is actually a better and more relevant thing to say. As irrational as they are, peoples comfort levels, personal beliefs, and fears are rational to consider for policy decisions. (All people have irrational beliefs , fears, etc - its just a fact of people).
I've taken fluoride supplements as a child and I've never had a cavity in my entire life. So with n=2, the evidence is overwhelmingly in favour of fluoride.
Scientists who work in government (DOE, EPA, etc) keep telling me that but I don't believe them. I worked alongside them and I wasn't impressed by most of them.
Result? I dodged a mini-Flint that occurred in my tiny corner of the Midwest. Two if you include the aftermath of Bethlehem, OH.
Anyway "rest of the world" is a spurious comparison. Im interested in comparing with Switzerland's water quality, not Eritrea's .
You said you don't consider water in the US to be potable. That's a much stronger claim than saying you don't entirely trust some of the peopel that work in government and certify the water.
Besides, I'm sure you can find independent studies verifying the water quality.
the difference being that it is very hard to avoid something added to the water supply, while it is usually possible to avoid the fortified varieties of food
You're probably confusing Fluoride which is actually quite difficult to remove, often needing expensive and complicated filtration such as Reverse Osmosis, with Chlorine which is trivial to remove with charcoal filtration.
I think you’re going to be surprised at how difficult it is to avoid iodized salt, whereas avoiding fluoridated water is as simple as buying a carbon or reverse osmosis filter (or buying filtered water).
Yes. Imagine if they put lithium in the water based on the evidence that microdosing it calms the population and reduces violence and overall mental health issues. That atomic number is a lot more controversial!
It should not be especially astonishing that public health programs for dental health and public immunity are substantially less controversial than putting a mood stabilizer in the water would be. Why conflate these as if one implies the other?
Actually, it doesn’t sound like a bad idea, IF it could be shown to 1. be effective and 2. cost the public less than the aggregate sum of individual mental health mitigations. A more mentally healthy, less violent, less aggressive, less belligerent society sounds great to me.
Because nature doesn’t care that one is intended for (m)ental health and one is intended for (d)ental health. They both are major interventions whose side effects are hard to isolate and reason about. What a difference an atomic number makes!
I don’t understand how nature enters into this argument. The decision to put fluoride in municipal water supplies is based on its effect on dental health, not a priori reasoning about elemental weights.
(Despite your assertion, the effects of fluoride, including their effects beyond safe levels in water, have been extremely well studied. Fluoride is well understood not to accumulate in soft tissue, and is present to some degree in much of the food you eat. If you drink a cup of tea a day, you’re already getting 6-8x as much fluoride as you’re getting from your municipal water supply.)
>The decision to put fluoride in municipal water supplies is based on its effect on dental health, not a priori reasoning about elemental weights.
Yes, and the decision to put lithium in municipal water supplies would be based on its effect on mental health, not on a priori reasoning about elemental weights.
Do you remember the comment you made? If not, I'll quote it for you:
>It should not be especially astonishing that public health programs for dental health and public immunity are substantially less controversial than putting a mood stabilizer in the water would be.
Your comment was an attempt to differentiate the two policies on the grounds that one is "for dental health" and one is "for mental health". I was replying that "what they're intended for" has no causal power (and thus shouldn't affect how controversial it is) -- the chemical mechanisms that play out don't look at policymaker intent. I don't know what you find so objectionable about that point.
As a courtesy, if you switch to a different, better argument, you shouldn't conflate it with the bad argument I was just replying to. But sure, I'll reply to the different argument.
>Despite your assertion, the effects of fluoride, including their effects beyond safe levels in water, have been extremely well studied.
Its understood now, was less so at the time. Doing it at the time seemed just as reckless as the lithium intervention, because the water supply is a system with many different touch points and many different interactions, same as with lithium and brains.
> I was replying that "what they're intended for" has no causal power (and thus shouldn't affect how controversial it is) -- the chemical mechanisms that play out don't look at policymaker intent. I don't know what you find so objectionable about that point.
It's not objectionable so much as it's backwards: policymakers can't control what a chemical or element does, but they can make policy decisions based on specific known properties of a chemical or element. It's not like we just YOLO'd fluoride into the water in the 1960s and have cargo-culted that practice into the present: the science on safe fluoride levels was sound back then, and continues to be substantiated by current research.
I think you read too much about "intent" into the original comment. The comment's whole point was that fluoride's value for dental health is incontrovertible, and was incontrovertible ~60 years ago. That's how it fits into the above. If there was any evidence either now or 60 years ago that municipal fluoridation at CDC levels did anything except improve the public's dental hygiene, then there would be a reasonable call for controversy here. But no such evidence exists.
On HN, it's the convention to put the year in the title when the article is older than a year or so. Readers often helpfully mention the year in such cases.
It doesn't imply anything about the relevancy of the content. Interesting older material is always welcome here!
Much of Europe has sufficient natural fluoride levels in the groundwater, often exceeding the amounts put in North American water supplies. Where this isn’t true, fluoridated salt is common (in my experience).
It seems that one or two European countries ban fluoridation; however few practice it. But "Europe banned this" is simply false. Moreover, it seems that there is fluoridation of salt instead (eg in Switzerland).
According to the other Wikipedia article, fluoridated salt where it is used (Switzerland and Germany) has about a 70% market share, so there is a choice for those who don't want it. It's a lot harder to opt-out of tap water.
> Nobody should be subjected to mandatory fluoride in their tap water.
Why? Just for the sake of freedom?
I think this raises an interesting question.
Suppose we have empirical irrefutable proof a practice is beneficial and doing so would not hinder anyone's lives whatsoever (as in, you don't have to change your lifestyle at all). Can this practice then be justified?
For example, suppose that fluoridating tap water (at least in the quantities present in most municipalities) was shown through many longitudinal studies to not have any adverse effects but was shown to have positive effects such as improved dental health. Would you support fluoridating water then?
So as long as we have proof of something being good, and no proof of it being bad - we should mandate it for all citizens? (it, referring to whatever you want)
Fluoride has been well proven to harm people in many ways. It's also one of the main causes of acne. It should not be forced upon people in their tap water.
It's entirely reasonable to object to population level health interventions. We don't have to shoehorn everything into the binary crisis, even if the narrative overlords are pleased for us to do their work for them.
The phrase and sentiment that I keep coming back to, that seems to work on both sides of the aisle, is something along the lines of "while I completely disagree, I absolutely understand where X is coming from in re...".
It's very telling that you can't get a "pro guns pro abortions" bumper sticker in the states.
The recent epidemiological results support the notion that elevated fluoride intake during early development can result in IQ deficits that may be considerable. Recognition of neurotoxic risks is necessary when determining the safety of fluoride-contaminated drinking water and fluoride uses for preventive dentistry purposes.
Environ Health. 2019; 18: 110. Published online 2019 Dec 19. doi: 10.1186/s12940-019-0551-x
PMCID: PMC6923889PMID: 31856837
Developmental fluoride neurotoxicity: an updated review
Philippe Grandjeancorresponding author1,2
Author information Article notes Copyright and License information PMC Disclaimer
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
2Department of Public Health, University of Southern Denmark, Odense, Denmark
Philippe Grandjean, Email: kd.uds.htlaeh@naejdnargp.
corresponding authorCorresponding author
With the usual caveat that in G20 countries, fluoridation is recommended at a concentration of 0.7 mg/L .. ie only added if levels are below that.
Fluoride meta studies, such as the one above, look at areas with extremely high levels of natural fluoridation, starting at least at one and half times the recommended dose and looking at areas with double, triple, and more that level.
There are issues in areas with high fluoridation levels, the fluoride and the other high metals levels in these regions in China and Mexico ...
But not basis for back propagating issues at high doses in multi metals areas to infer issues at the lower recommended dose rates.
> Fourteen recent cross-sectional studies from endemic areas with naturally high fluoride concentrations in groundwater supported the previous findings of cognitive deficits in children with elevated fluoride exposures. Three recent prospective studies from Mexico and Canada with individual exposure data showed that early-life exposures were negatively associated with children’s performance on cognitive tests. Neurotoxicity appeared to be dose-dependent, and tentative benchmark dose calculations suggest that safe exposures are likely to be below currently accepted or recommended fluoride concentrations in drinking water.
Having said that, the linked paper also notes that the benifits of flouridated water do not seem to be significant (likely do to the widespread use of flouridated toothpaste).
Note that the association is for levels far higher than those used in drinking water. An updated meta-review (https://www.nature.com/articles/s41598-021-99688-w) also suggests an association between high fluoride intake and lower IQ, but notes that the quality of evidence is very low. It suggests that there is no evidence that low-to-moderate levels, like those used in drinking water, pose any neurotoxic effect; if there are effects, they may only be present at levels 3-10x higher than recommended fluoridation levels.
Many countries across the world refuse to add fluoride. It's mainly a US and Australia thing. The fact that NPR is on board without even reporting the other side of the coin is just pure state propaganda.
Many countries around the world have natural fluoride in their groundwater (much of Europe), use other dietary sources for fluoride (salt), or have a significant dietary component that naturally contains fluoride (tea).
What makes water fluoridation good public health policy isn’t that we do it blindly; it’s that it gets balanced against demographic and geographic factors that don’t necessary apply everywhere else in the world.
That map shows regions exceeding 1.5mg/L, i.e. over twice the amount that the US and other countries place in their municipal water supplies. It’s not a map of places with suitable concentrations of fluoride in groundwater; it shows excess amounts.
To my understanding, both Switzerland and Germany have around 1.0mg/L fluoride in much of their groundwater. This puts them firmly above municipal levels in the US, but below what your map shows.
> Katie Mather, who lives in Richmond, a town of about 4,100 in northwestern Vermont, said at a water commission meeting this week that her dentist recently found her two kids' first cavities. She acknowledged they eat a lot of sugar, but noted that her dentist recommended against supplemental fluoride because the town's water should be doing the trick.
People can get conspiracy about this as much as they like, but at the end of the day, it's money. Diet is one of the largest factors in dental health and the average American diet is high in sugar. People can barely afford going to the hospital let alone a dentist. This is quite measurably the cheapest way of preventing millions of people becoming a burden to the healthcare system.
In this thread, we will see the method of reasoning where people decide conclusions that are unacceptable and then proceed to dismiss as false by definition all facts and data that lead to any one of those unacceptable conclusions.
86 comments
[ 3.3 ms ] story [ 151 ms ] threadVery interesting way of thinking about that. I understand the benefits of fluoride but I also understand this sentiment.
(You were told not to swallow the fluoride in school because it’s significantly more concentrated than contents in the water supply. The dose makes the medicine and the poison.)
(Saying that fluoride accumulates profoundly misses the point: it is supposed to accumulate. What fluoride doesn’t do is accumulate in soft tissues, which is why acute exposures to high doses of fluoride don’t guarantee intellectual forestallment like lead frequently does.)
That there are places around the world that have high with F doesn't make it safe. There are places in the world that had catastrophically high rates of cretinism. Turns out it was a natural factor in an otherwise idyllic natural setting.
I am aware that fluorine is supposed to accumulate in your teeth and doesnt in "soft" tissue; but it also accumulates in your bones and anywhere there is calcium.
Bones and teeth are not dead scaffolding, but an integral part of your body's biochemical system. I should know - they gnawed a hole into my hip to get at my marrow.
Again: it’s supposed to bioaccumulate there. Bioaccumulation is a part of homeostasis; the fact that iron (calcium, etc.) bioaccumulates is neither a reason to avoid it nor to exceed a healthy dietary quantity. And the evidence is overwhelmingly supportive of municipal fluoride levels being both safe and sufficient for dental health.
The whole thing with fluoridated water is that whilst small doses may be harmless for most people, the more you consume the worse it is, and plenty of people - based on official recommendations - drink a lot of tap water each day.
What figures can you point to on mg/L of fluoride in (commonly consumed) green tea vs tap water?
Even aside from that, it’s a specious argument: people who want to avoid fluoride can just avoid green tea; it’s much harder to avoid it in tap water.
As for “delusional panic”: it matters a lot for iodine absorption and thyroid function for some people, which is a both widespread and overlooked/diminished, at great harm and cost to those who are affected and unable to get help.
For what it’s worth I’m not advocating for removal of fluoride from tap water, but there does need to be more recognition of the harms to those affected and serious efforts made to develop treatment approaches for those with iodine deficiencies and thyroid dysfunction, as it really is a catastrophic problem for a lot of people.
Municipal tap water in the US is fluoridated between 0.7mg/L and 1.2mg/L, per the CDC's 1962 guidelines[1]. To my knowledge, most municipalities choose the lower end of that range (since the effects are diminishing and, well, it's cheaper).
By contrast, at least one survey of black tea infusions finds an average of 2.65mg/L[2]. So over twice the CDC's highest baseline for municipal fluoridation.
(Note: at that average for black tea, an adult would still need to drink ~4L of black tea a day to pass the CDC's tolerable upper limit. People grossly overestimate both how much fluoride is dangerous, and how much they actually consume.)
[1]: https://stacks.cdc.gov/view/cdc/5160
[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672222/
https://pubmed.ncbi.nlm.nih.gov/34343066/
General discussion: https://en.wikipedia.org/wiki/Health_effects_of_tea#Fluoride...
Your relationship with cavities doesn't change anything about the statistics of cavities with and without flouride in people's diet.
I was merely pointing out that your anecdote is already part of the statistical evidence and not particularly useful to a discussion of whether it should be added to water
"I don't want it in my water" is actually a better and more relevant thing to say. As irrational as they are, peoples comfort levels, personal beliefs, and fears are rational to consider for policy decisions. (All people have irrational beliefs , fears, etc - its just a fact of people).
It is impossible to buy non-fluorinated drinking water that is not orders of magnitude more expensive than tap.
Then again, I don't consider tap water to be potable in the US so I guess its a wash.
That's a weird sentiment considering the US has some of the highest quality drinking water in the world.
Result? I dodged a mini-Flint that occurred in my tiny corner of the Midwest. Two if you include the aftermath of Bethlehem, OH.
Anyway "rest of the world" is a spurious comparison. Im interested in comparing with Switzerland's water quality, not Eritrea's .
Besides, I'm sure you can find independent studies verifying the water quality.
Furthermore, as others mentioned, Huxley would like a word.
(Despite your assertion, the effects of fluoride, including their effects beyond safe levels in water, have been extremely well studied. Fluoride is well understood not to accumulate in soft tissue, and is present to some degree in much of the food you eat. If you drink a cup of tea a day, you’re already getting 6-8x as much fluoride as you’re getting from your municipal water supply.)
Yes, and the decision to put lithium in municipal water supplies would be based on its effect on mental health, not on a priori reasoning about elemental weights.
Do you remember the comment you made? If not, I'll quote it for you:
>It should not be especially astonishing that public health programs for dental health and public immunity are substantially less controversial than putting a mood stabilizer in the water would be.
Your comment was an attempt to differentiate the two policies on the grounds that one is "for dental health" and one is "for mental health". I was replying that "what they're intended for" has no causal power (and thus shouldn't affect how controversial it is) -- the chemical mechanisms that play out don't look at policymaker intent. I don't know what you find so objectionable about that point.
As a courtesy, if you switch to a different, better argument, you shouldn't conflate it with the bad argument I was just replying to. But sure, I'll reply to the different argument.
>Despite your assertion, the effects of fluoride, including their effects beyond safe levels in water, have been extremely well studied.
Its understood now, was less so at the time. Doing it at the time seemed just as reckless as the lithium intervention, because the water supply is a system with many different touch points and many different interactions, same as with lithium and brains.
It's not objectionable so much as it's backwards: policymakers can't control what a chemical or element does, but they can make policy decisions based on specific known properties of a chemical or element. It's not like we just YOLO'd fluoride into the water in the 1960s and have cargo-culted that practice into the present: the science on safe fluoride levels was sound back then, and continues to be substantiated by current research.
I think you read too much about "intent" into the original comment. The comment's whole point was that fluoride's value for dental health is incontrovertible, and was incontrovertible ~60 years ago. That's how it fits into the above. If there was any evidence either now or 60 years ago that municipal fluoridation at CDC levels did anything except improve the public's dental hygiene, then there would be a reasonable call for controversy here. But no such evidence exists.
It doesn't imply anything about the relevancy of the content. Interesting older material is always welcome here!
It seems that one or two European countries ban fluoridation; however few practice it. But "Europe banned this" is simply false. Moreover, it seems that there is fluoridation of salt instead (eg in Switzerland).
https://en.wikipedia.org/wiki/Water_fluoridation#Worldwide_p...
Why? Just for the sake of freedom?
I think this raises an interesting question.
Suppose we have empirical irrefutable proof a practice is beneficial and doing so would not hinder anyone's lives whatsoever (as in, you don't have to change your lifestyle at all). Can this practice then be justified?
For example, suppose that fluoridating tap water (at least in the quantities present in most municipalities) was shown through many longitudinal studies to not have any adverse effects but was shown to have positive effects such as improved dental health. Would you support fluoridating water then?
The phrase and sentiment that I keep coming back to, that seems to work on both sides of the aisle, is something along the lines of "while I completely disagree, I absolutely understand where X is coming from in re...".
It's very telling that you can't get a "pro guns pro abortions" bumper sticker in the states.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923889/
Conclusion
The recent epidemiological results support the notion that elevated fluoride intake during early development can result in IQ deficits that may be considerable. Recognition of neurotoxic risks is necessary when determining the safety of fluoride-contaminated drinking water and fluoride uses for preventive dentistry purposes.
Environ Health. 2019; 18: 110. Published online 2019 Dec 19. doi: 10.1186/s12940-019-0551-x PMCID: PMC6923889PMID: 31856837 Developmental fluoride neurotoxicity: an updated review
Philippe Grandjeancorresponding author1,2 Author information Article notes Copyright and License information PMC Disclaimer 1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA 2Department of Public Health, University of Southern Denmark, Odense, Denmark Philippe Grandjean, Email: kd.uds.htlaeh@naejdnargp. corresponding authorCorresponding author
Fluoride meta studies, such as the one above, look at areas with extremely high levels of natural fluoridation, starting at least at one and half times the recommended dose and looking at areas with double, triple, and more that level.
There are issues in areas with high fluoridation levels, the fluoride and the other high metals levels in these regions in China and Mexico ...
But not basis for back propagating issues at high doses in multi metals areas to infer issues at the lower recommended dose rates.
> Fourteen recent cross-sectional studies from endemic areas with naturally high fluoride concentrations in groundwater supported the previous findings of cognitive deficits in children with elevated fluoride exposures. Three recent prospective studies from Mexico and Canada with individual exposure data showed that early-life exposures were negatively associated with children’s performance on cognitive tests. Neurotoxicity appeared to be dose-dependent, and tentative benchmark dose calculations suggest that safe exposures are likely to be below currently accepted or recommended fluoride concentrations in drinking water.
Having said that, the linked paper also notes that the benifits of flouridated water do not seem to be significant (likely do to the widespread use of flouridated toothpaste).
Many countries across the world refuse to add fluoride. It's mainly a US and Australia thing. The fact that NPR is on board without even reporting the other side of the coin is just pure state propaganda.
What makes water fluoridation good public health policy isn’t that we do it blindly; it’s that it gets balanced against demographic and geographic factors that don’t necessary apply everywhere else in the world.
This seems to refute your claim about Europe:
https://www.nature.com/articles/s41467-022-31940-x/figures/1
However, another study seems to indicate Germany is particularly at risk in Europe of high fluoride concentrations: https://www.sciencedirect.com/science/article/pii/S167498712...
To my understanding, both Switzerland and Germany have around 1.0mg/L fluoride in much of their groundwater. This puts them firmly above municipal levels in the US, but below what your map shows.
People can get conspiracy about this as much as they like, but at the end of the day, it's money. Diet is one of the largest factors in dental health and the average American diet is high in sugar. People can barely afford going to the hospital let alone a dentist. This is quite measurably the cheapest way of preventing millions of people becoming a burden to the healthcare system.
Some more discussion then: https://news.ycombinator.com/item?id=33292353