Fluoride in Drinking Water: Is It Safe?

From the lecture series: The Skeptic's Guide to Health, Medicine, and the Media

By Roy Benaroch, MD, Emory University

Fluoride is added to many municipal water supplies to combat tooth decay. But some studies have shown that fluoride in drinking water can be harmful to pregnant women and their unborn fetuses, potentially lowering the child’s IQ. Let’s take a closer look at these studies to determine whether this is the case.

Image concept for fluoride added in drinking water
(Image:  gotphotos/Shutterstock)

What Are Toxins?

When we hear the word “toxins,” we often think of dangerous chemicals lurking in our food, water, and cosmetics. At least that’s what the media would have us believe.

However, that word, when used in a medical context, refers specifically to poisonous substances that are produced by living cells or organisms.

These, by their proper definition, are natural substances, produced by organisms as a result of natural selection, typically to defend themselves against other organisms.

Plants and mushrooms make their own toxins—in fact, their own pesticides, herbicides, antimicrobials, and poisons to better survive.

You’re probably familiar with the story of the discovery of penicillin by Alexander Fleming. The antibiotic, penicillin, was naturally made by a mold organism to protect itself from bacteria.

This is a transcript from the video series The Skeptic’s Guide to Health, Medicine, and the Media. Watch it now, Wondrium.

classic study from 1990 showed that the vast majority by weight of pesticides—the chemicals that kill pests—found in garden vegetables were made by the vegetables themselves, not sprayed on by farmers. 

What happens to all of these toxins? It turns out that our bodies are remarkably adept at handling them, or at least most of them.

Image of Liver with Kidneys
Livers and kidneys detoxify our blood, to process chemicals in pesticide nto less-toxic forms. (Image: Magic mine/Shutterstock)

It is the job of our livers and kidneys to detoxify our blood, to process these chemicals into less-toxic forms, and then excrete them outside in waste. The physiology is truly remarkable.

None of this, by the way, has anything to do with what’s advertised as detoxing supplements, foods, or special diets. That’s all quackery and entirely unnecessary.

The fact that such products have become so popular is a testament to marketing genius. They’re nothing you need to spend any money on.

Learn more about how we share our world with toxins

Mounting Concerns over Fluoride in Water

Nevertheless, there are certainly toxic chemicals in our environment that are cause for concern and can have a hugely negative impact on human health. This is demonstrated by the Flint, Michigan, water crisis in which lead was discovered in the residents’ water supply.

Then, other chemicals in our water supply appear on the surface to be harmful but, upon closer inspection, are relatively benign.

Water purification plant filtration process explanation vector illustration. Labeled steps from raw resource to sedimentation, filtering, disinfection and storage to safe and clean home consumption
Fluoride is added to many municipal water supplies to combat tooth decay. (Image: VectorMine/Shutterstock)

Fluoride is added to many municipal water supplies to combat tooth decay, and there is substantial—close to overwhelming—proof that it’s safe and effective.

But a study in Mexico raised some alarms in 2017. Headlines included this from Newsweek: “Children’s IQ Could Be Lowered by Mothers Drinking Tap Water While Pregnant,” or, even more alarming, from Reader’s Digest: “If You Drink This Type of Water During Pregnancy, Your Child’s IQ Could Suffer.”

CNN’s title more accurately reflected the study that was done: “Fluoride Exposure In-Utero Linked to Lower IQ in Kids, Study Says.”

Unfortunately, most of these fluoride headlines overstated what the study showed. To better understand that, we have to look at the study itself.

Learn more about the very real dangers of over-diagnosing

Causation or Correlation?

The study was done in Mexico, on a population quite different from ours, in a community where fluoride is not added to the water. It was an observational study, not an experimental study, that looked at a single measurement of urinary fluoride during pregnancy, and correlated that with measures of intelligence when the children were ages 6 to 12 years.

The findings are interesting, but this kind of study cannot show that it was the fluoride exposure that caused differences in intelligence. Maybe there were other, more important environmental differences, differences in the mother’s diet, or other factors in different neighborhoods that affected both urinary fluoride concentrations and fetal development.

Observational studies like these aren’t meant to look at what causes what, just at what is associated with what. That’s a huge difference, one that the editors of Reader’s Digest and Newsweek didn’t seem to appreciate.

Also, as the CNN article stated, a prospective study on fluoride and intelligence was done in New Zealand in 2015, in this case looking prospectively over 38 years at children receiving varying levels of fluoride in early childhood, and comparing that exposure to repeated IQ testing.

There was no association found. Even in the highest doses, early fluoride exposure was not associated with lower IQ. Context, again, is key—look for that in media accounts. Do stories put the new information into context with what’s already known?

Chemicals in Food and Water: The Bottom Line

It’s difficult to say with certainty that a chemical at a certain concentration in the environment is 100% harmless to everybody, all the time, no matter what the circumstances and other exposures might be.

What we do know is that humans have evolved to deal with almost all of the chemicals in our food and water. Some of these chemicals are there naturally, like the natural amount of fluoride in the water in Mexico; sometimes we add extra for health benefits like the fluoride added to drinking water in the United States.

The vast majority of biologically active compounds found in foods are there naturally, as components of the food itself.

But we also add other chemicals, sometimes natural or synthetic pesticides, for instance, or fertilizers used to make food easier or less expensive to grow. Modern agriculture and water treatment have provided us with food and water that’s cheap and abundant.

But we need to maintain our vigilance to make sure it stays safe. The media can do an important job here, serving as both a watchdog of consumer concerns, like in Flint, Michigan, and as a way for people to learn about new scientific knowledge.

But the forces driving the business of media news—increasing eyeballs and clicks and shares—does tend to favor news that overstates the issue at hand.

Learn more about how to think like a skeptic when reading news in any medium

There’s a difference between capturing public attention to address genuine issues and using clickbait to scare people.

Common Questions About Water Fluoridation

Q: How safe is fluoridation of water?

According to most studies, water fluoridation is not only safe but extremely effective at fighting off tooth decay.

Q: When did the US water fluoridation program begin?

Water fluoridation in the US started in 1945 in Grand Rapids, Michigan. The city became the first to increase the fluoride in their water supply to 1.0 ppm.

Q: Is fluoridated water safe for babies to drink?

According to the ADA, fluoridated water is safe for babies to drink when mixed with formula. They shouldn’t drink excess as it can cause a condition called fluorosis where teeth become discolored.

Q: Is bottled water fluoridated?

Bottled water will almost always carry some percentage of fluoride depending on the source. If the bottle states that it has been steam distilled or treated to remove it, then it should not contain fluoride.

This article was updated on November 27, 2020

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