let's talk about fluoride i've already been accused of being a sunscreen denier no i actually believe that sunscreen exists i do occasionally use zinc oxide sunscreen a little bit i prefer a physical barrier because i'll wear a hat or something if i i don't tend to burn very easily but if i feel like i might burn i use a physical barrier um i'm being somewhat facetious here because people will say all sorts of things but um i did an episode about water a little bit about oral health certainly not the depth or expertise that you're providing today so thank you and i said yeah fluoride does a bunch of things my question was and remains why are we drinking fluoride but this relates to okay i'll tell this story briefly it's not as cool as your story i was taken to a dentist when i was a kid and they put me they put these like a like a mouthpiece with fluoride gel in it on the top and bottom and they sat me in a little wicker chair in front of a tv with cartoons and i hated it it tasted awful and it kind of like had this sour thing so i was probably six or seven so i drank it i just sucked it up drank it down turned around barfed all over the wicker chair oh my gosh fluoride's a poison but everything is a poison at high concentrations so most everything is a is a fluoride is a poison excuse me at high concentrations so i don't have anything against fluoride but it is a poison then the question becomes if something is not dangerous in a small dose or concentration what are its cumulative effects this is what this is what i have issues like people say oh going through the x-ray machine no big deal but what if you fly 150 times a year yes is it cumulative and so like the logic of the the sort of pushback from the traditional if i will uh community sucks like they're just not logical these are my colleagues sometimes too right just you go to the dentist to get an x-ray they're like running behind the the next wall put you in a lead shield and then they're like oh no it's no big deal well how many you know maybe how many times a year can you do this before it becomes ideal so my question is what is the rationale for putting fluoride in water in drinking water given that the contact time in the mouth is so short and then what what's the cumulative effect of bringing fluoride into the gut over and over and then earlier you said something and i've never thought about this the bones contain hydroxyapatite 60 i think you said 60 of your bone minerals are made from hydroxyapatite fluoride infiltrates the minerals of the teeth and replaces it so is fluoride going into our bones skeletal fluorosis okay so i'm not trying to paint a scary picture here but but frankly and people can probably tell my blood pressure goes up a little bit when people say oh you know you're anti-fluoride i'm not anti-fluoride but i just don't get the logic it doesn't make sense you're thinking critically about the about it like why would i continually bombard my system with fluoride at the level of the gut at the level of my bones if it's good for me tell me it's good for me but they're saying oh it's so that poorer populations don't have uh decaying teeth sounds like a good argument not even counter-arguing it but i can't piece together the logic and like most public health arguments i feel like neither side is is explicitly clear about what exactly they're arguing about and that's part of why i have this podcast to try and get clarity okay i'll do my best yeah and please don't worry that you're gonna offend anyone because i'll offend everybody and they've already said anything they everything they possibly could and they'll and they'll say more so i'm not afraid to open up these topics anymore i appreciate that and and i'll take the heat i well i will get it too don't worry i've already i have thick skin at this point but you have great teeth and they don't so and i haven't had a cavity for multiple decades and haven't used fluoride and portland isn't fluoridated portland is not it is not so let's talk about that so fun story uh back in 2011 2012 i was working on the pro water fluoridation campaign volunteering in portland picketing and handing out educational flyers um because i thought we needed it in our water and this is because that's how i was trained um and i just never questioned it i never picked up a journal to look at the other side i thought anyone speaking out against water fluoridation that's the tin hat brigade that's the woo woo caucus all the things i was that person the woo woo caucus that's pretty funny yeah so i went to a debate um in portland pro versus against i don't like those terms but it's just the easiest way to describe it and i was sitting kind of on the pro side and just waiting to see these pseudoscientists come out to to speak and i was so profoundly impressed with what they said and also had no idea that there were any concerns with with fluoride i'd never been taught that in dental school the endocrine disruption the neurotoxicity um this the skeletal fluorosis i knew about dental fluorosis but i at that point was of the mindset well it's just aesthetic you know but your teeth are stronger and the microbiome issues too so it didn't take long i just started rabbit holing and there's so much literature and this again this was quite a while ago um and more and more data in literature is coming out to question the practice so it's important to go back to the history of water fluoridation i'll try to be brief but in the early 1900s there was a dentist in colorado springs frederick mckay who noticed his patients had mottled um brown spotted teeth but they were really strong they weren't getting decay and so this kind of spread and they started kind of trying to understand the why and they realized there was a really high concentration of fluoride in the natural water supply that this community was drinking and this just kind of spread like wildfire with very little evidence-based medicine to back it because this was in the early 1900s now it was like the 1930s um so no long-term safety studies or efficacy studies and it was put in as an experiment in grand rapids michigan in the mid-40s after about a decade or so they noticed that caries rates cavity rates were going down and so based on this observation it just went like wildfire throughout the united states and i believe about 80 percent of the united states is fluoridated so the pro advocates if you will will say it's the greatest public health movement of the the century because decay was such an issue it's important to know dental decay is the top chronic disease globally in children and adults it's almost entirely preventable i think we've just normalized it you just get cavities but i'd like to point out we're one of the only species to get dental decay wild animals don't get decay our domesticated animals do because of what we're feeding them the kibble you know processed animal food so here we are so it's been controversial from the beginning you know epidemiologists endocrinologists neuroscientists have always challenged it saying this is a bad idea it's a highly reactive element you know the fluoride ion um can interfere with iodine um uptake and again skeletal fluorosis neurotoxicity etc so about seven years ago um there there was the people there's a federal trial in northern california but it was federal the people versus the epa it was a task a trial and this has been ongoing for the past seven years and basically they were saying where is your safety data epa on the long-term effects of water fluoridation so the idea was that if we put it in the water it's not a very efficient way to get fluoride to people but eventually it may will make itself into the saliva and have a topical effect coming out through the saliva they used to think systemically it was actually incorporating into the developing teeth and children making the enamel stronger that way but that's been debunked so now it's most likely still a topical benefit maybe a little bit of a systemic benefit touching the teeth um and we do know fluoride really needs to work topically we don't need to be ingesting it and that is all through the data and they're teaching that in dental schools now too okay but this is the easiest way to get fluoride to the masses because caries or cavities are such an issue now my first comment on this is we're not addressing the root cause of dental decay which is our food it's all the ultra processed foods again we didn't really see dental decay in humans until the agricultural revolution the industrial revolution and now the ultra processed food craze that's been happening the past many decades okay is that right so if we look at skeletons from dead people obviously well you can look at skeletons alive people skeletons and dead people uh from dead people that um died prior to 1900 how are their teeth 1900 they still have they would have decay but if you looked at about 10 000 years ago um very little you know unless they lived in an area with a lot of fruit abundance or honey like where are you getting your sugar from you know and you go pick some berries on a bush you're competing with the animals and the birds you didn't have much opportunity to over consume sugar um but you know there was the sugar trade and then we just sugar was a sign of wealth and royalty and people's teeth just rotted out and it was because of our diet so that's the root cause issue that no one's talking about you know we're just saying let's slap fluoride on it how about we educate and teach people what is really causing cavities but anyway okay so the task of trial was going on and the judge um judge edward chen was waiting for this national toxicology programs report which was under the department of health and human services and this is it reads like a soap opera to be honest with you um and it kept getting delayed and and um postponed and they wouldn't release it and finally under the freedom of information act he said this needs to be released and it said there is a strong correlation between increased fluoride consumption and iq issues in children um and so with that he he took this information and he made his ruling now this was after years of expert testimonies as well okay um saying there's an unreasonable risk to current water fluoridation practices in the united states this was his ruling that just happened late last year i mean it's this is very new and epa you now need to fix this you need to regulate this better what people will argue is a lot of the studies they were looking at that are showing lowered iq and children or neurocognitive issues it was at 1.2 or 1.5 milligrams per liter of you know um that was the concentration the united states we now do 0.7 milligrams per liter but what this that's per liter okay so how many liters of water do you drink a day this is the controversy so for example the american academy of pediatrics generally recommends pregnant women drink two to three liters a day um you might be cooking with fluoridated water making your pasta making your soup um how do we really know how much someone's getting exposed to what's their body composition how much do they weigh what are the other outside sources of fluoride are they swallowing their toothpaste fluoride is in many pharmaceuticals because it helps increase bioavailability especially um ssris and prilosec a lot of these have fluoride in them really yes ultra processed foods will have fluoride so the factory that's making your rockstar energy drink or your high c or you know whatever you're consuming they're not using reverse osmosis to filter the water so you're getting fluoride that way it's naturally found in green tea and black tea and this is not to make people worried about green and black tea i still consume them it's more to say how are we really understanding how much is exposed to and so they were finding that pregnant women um they follow there's many studies now but a famous one was rifka green study out of canada and they followed about 520 mother child pairs um they tested urinary fluoride and the mother per trimester averaged it and then followed these children to the age of three or four and did iq tests and found that mothers who had higher concentrations of urinary fluoride the children tested lower on their iq tests up to five to seven points and that's on par with lead okay on par with lead on par with lead yes and so that was in 2019 there's been so many more studies now so the judge ruled epa you need to regulate this better in that amount of time there was a meta-analysis that came out that further supported the ntp report by jama pediatrics okay and this is very controversial for these editors to be putting out by the way so i commend them um and also a a cochrane report came out cochrane collaborative which has said this again was very recent looking at all the data from water fluoridation water fluoridation isn't reducing decay like we thought it was it's only reducing decay by about one quarter a cavity per person one quarter of a cavity per person so that's not statistically significant so people will say well what gives why were cavity rates going down when we added fluoride to the water well it's hard to say maybe they were already just going to going down due to education more access to dental hygiene and toothbrushing flossing um but also we now have fluoride everywhere in our toothpaste so fluoride was put in the water in the 1940s it wasn't added to our toothpaste until the 1960s and now it's everywhere we get fluoride everywhere rinses the varnishes that made you vomit at the office and by the way that's very common that's very common and it's because a lot of those fluoride varnishes um number one fluoride you know it does have a poison control label on it you're not supposed to swallow it but these varnishes also have polyurethane and hexane derivatives and then it's what makes them so sticky yeah i i still loathe going to the dentist i think i think it's because of that that um early association yeah yeah so it's very controversial and unfortunately we've lost sight of the science it's getting buried in politics right now and it really upsets me because it's not a political issue we just need to look at the data and i feel like we're losing sight of the scientific method um we you know the american dental association the american academy of pediatrics is doubling down on saying we have to put fluoride in the water and for nothing else i think it's important to know 97 of the world does not fluoridate their water this is a very united states controversy um many countries removed it and found i think it was denmark germany japan they have very low decay rates and why is this well they educated their population on what's really causing decay and also made fluoride toothpaste accessible and i have danish relatives they have very nice teeth if you told me that there's no fluoride in the drinking water in england i might um i might uh like well you know sorry my english friends but that's the stereotype right that their teeth are bad i don't think that that's true any longer i think that that uh was true at one point that i think they're crowded and crooked too and a lot of that has to do i think with facial development as well i think we're we see a lot of um western european they do have that kind of dysmorphic face if you will probably from nasal breathing who knows why industrial revolution allergies mouth breathing etc why did it why does it seem more prevalent there um so that's this that's the the take the quick take on it and so i just think it should be a personal choice you know if you want to use fluoride you can go out to the store i mean you can get fluoride toothpaste at the dollar store now they give it out for free at many clinics um to me i just think it's a it's a medical ethical issue we're mass medicating a population without their consent and then the even bigger issue for me is no one's talking about this nor can i find any literature on it what is it doing to the gut microbiome because it is an antimicrobial so that would be a wonderful study nih if you're listening can we test you know people that live in fluoridated areas versus those that don't can we follow them maybe it's a prospective cohort study to just see how their microbiomes are different because it just doesn't make sense to me and why would we ingest something systemically with all these potential risks when we could just use it topically or actually talk about what's really causing decay if fluoridation worked it cavities wouldn't be the top disease in our country in our children and many worry well if we take it from the water decay may go up and it may i mean there's been they've they did this in calgary canada where decay rates went up but then if you actually look at the data the decay rates were already going up when they removed it but they only show you the data that they kind of want to show you for that so um but again it's a risk benefit analysis i mean i think dentists tend to be too focused on teeth and so you mentioned like if they say it's good for me i'll do it well good for what good for your teeth or good for your whole body or good for your brain and i think that should be an individual choice are you for as a parent do i want to choose one quarter less cavity in my child or do i want to preserve their optimal brain development i mean the the data that show deficits on par with what one sees with lead exposure that's the most striking yeah thing to me yeah and i'm a dentist i was trained to fix teeth i can fix a one quarter cavity in a tooth i can't fix a developing brain we have one shot to develop a brain we have one shot to grow a face you know it's really important i really appreciate you taking us through the full arc of the history of it i think it's extremely important that people take that in so they can start to form their own opinions and um you pointed out a number of um logical flaws in in just the the way the whole system is is um arranged right now which is this mass uh treatment of everybody with a with a potent chemical especially given the amount of water that people drink and cook with etc and without their consent and um and without a risk assessment so you're low decay rate i might be a really high decay rate you you don't need anything extra your diet your balance your microbiome's great i'm not eating well my hygiene's terrible you know we we can't just blanketly be treating everyone the same we're supposed to be doing risk assessments okay so i think that pretty much puts fluoride in a not in a box let's say on the shelf for all of us to look at i think this is going to be a very important aspect of public health in the year to three years to come with this new administration and bobby kennedy paying a lot of attention to fluoride and i really like what you said about trying to remove the political aspects of this if this becomes a um blue versus red left versus right thing we're never going to get to the heart of the matter um yeah and that would be really sad and the ones that would really suffer would be kids the children so a uh a non-partisan uh look at this which is how i heard everything that you said um just seems really critical uh where are they getting the fluoride so water fluoridation um the fluoride that they get is a byproduct of the phosphate fertilizer industry and it's it's called hydrofluorosilicic acid so as a byproduct of the phosphate fertilizer industry it's considered a hazardous waste and it's very expensive to dispose of uh but they have found that if diluted in theory and put it's an acid first of all so if it's put into our water system it is so diluted that it becomes safe but i will say it you know everyone can go research this and look at themselves but it does come in like cement bags with skull and crossbones on the front and they do have to wear hazmat suits to put it into our water um they're supposed to titrate it and i think what's interesting you know we're supposed to target 0.7 milligrams per liter um i've been involved in some educational campaigns and and have tested communities surrounding portland it's very hard to keep it in range you know and so there are some communities testing as high we've seen as 2.2 milligrams per liter which definitely falls into based on the the science and literature more concerning zone for neurocognitive issues and other health issues so um if you're concerned you can call your local water um bureau municipality i will say i don't think the federal government's going to have much control over this it would be nice if the epa stepped in um they have appealed by the way uh but it will come down to more like on the state level and local level and we're already seeing states like florida and utah um have run it through and initially done a we're going to ban this um as a mandatory thing in our state and i think it's uh north dakota kentucky there's other states picking this up too and other communities that are removing it or or not adding it to their water so it's an interesting time to observe all of this