ABCs of Fluoridation
Written by Richard A. Kunin, M.D   


1.  AB 733,

The California fluoridation bill became new law in California, as of January 1, 1996. This foolish law mandates fluoride treatment of all California public and private water supplies serving over 10,000 consumers. At a time when we have had our “green revolution,” environmentalism, to rescue our polluted planet; at a time when our EPA cannot accomplish their charge, the cleaning up of thousands of toxic waste sites, we now have the California state government dumping toxic fluorides into our public water supplies and thence into our bodies. We, ourselves, have become toxic waste dumps!

The fluoridation bill was authored by Assemblywoman Jackie Speier and skillfully ushered through the legislative process last summer without fanfare, and signed by Governor Pete Wilson in September, 1995. Unless you buy non-fluoridated bottled water or distill (not filter) your own tap water, you are going to ingest an excessive amount of fluoride in your drinking water, coffee, soup and boiled foods for the rest of your life, wherever you go in California. There is no escape--except to repeal AB 733!

Until now the voters in Los Angeles, Sacramento and San Jose have refused to join San Francisco, San Diego and Oakland in fluoridation. In fact, 76 other municipalities have rejected fluoridation and only one out of six Californians drinks fluoridated tap water.  However most of us do get fluoride in mineral waters, soft drinks and reconstituted juices, almost all of which are made with fluoridated water!  In fact, since artificial waters now represent more than half the water intake of the average American, it is totally unnecessary to fluoridate the water supply for the purpose of medicating the population. We are already fluoridated via our soft drinks--not to mention toothpaste. In fact, our food supply is now so full of fluoride that the average American is overdosed already without drinking any tap water at all.

I hope to make clear the main reasons I oppose fluoridation of the public water supply and that is why I have chosen the alphabet A-G to order the basic ideas.  Because I am a physician, my mind is trained to consider public health interventions in terms of benefits and risks.  Fluoride has been sold to physicians, dentists and our politicians as all benefit and no risk.  It is supposed to reduce dental caries by 60 percent and cause no adverse effects.  Not so.

After 50 years the statistics tell a different story: a possible benefit, but at most 20 percent, far less than the 60 percent reduction in caries touted by the proponents. There appears to be a narrow therapeutic window for fluoride in water at a concentration between 0.2 and 0.5 parts per million. This is more than 50 percent lower than the 1 part per million dose (1 milligram per liter of water) recommended as “optimal” by the public health establishment.

On the other hand the dangers of fluoridation are not to be ignored. Lives have been ruined and a few have been lost because fluoride also has a narrow window of safety. The EPA classifies fluoride as a contaminant when it is present in water at concentrations of 4 parts per million. In other words, at just four times the “optimal” concentration, fluoride is acknowledged a pollutant--a poison. But it is not just the concentration of fluoride that makes it dangerous, it is the actual amount ingested that counts. Some people actually drink four times more water than the usual 1 to 2 liters per day.  Athletes, joggers, laborers, diabetics, those with diabetes insipidus, and even some healthy people living in hot climates.  For them fluoride is not controversial.  It is a poison.

Kidney damage reduces the ability of the kidney tubules to rid the body of fluoride and there are over 13 million of our countrymen with acute and chronic kidney[i] disease. Most of them don’t know until late in the disease that they have partial renal failure. The routine chemical tests don’t reveal this until the kidneys are about 70 percent non-functional.  Is it fair to these millions of people to force them to ingest a toxic substance that they are unable to get rid of; one that will inevitably accumulate in their tissues and cause symptoms?



This build-up of fluoride in the tissues affects everyone, not just those with kidney disease. This is the main difference between fluoride and chlorine: over the years the amount of fluoride in our bones increases over a thousand-fold, and in some areas of our brain over ten-fold. Chlorine, on the other hand, does not build up in our tissues and so we accept fluoride as if it is comparable. It is not. In the first place, chlorine is life-saving: it prevents epidemics of dysentary that would cripple our cities and kill our children and our elderly. Thus, even though chlorination contributes to colon cancer, the trade-off has been worth it.

But fluoridation is a different matter.  Its purpose is the preservation of teeth, not life. How well does it work? The demonstrated dental benefit in 39,000 school children, comparing lifetime fluoridated to non-fluoridated water, comes to about a half of one tooth surface out of 128 surfaces per 28 teeth[ii]. Not much to brag about. And, unlike chlorine, that passes through the body quickly, fluoride is largely retained and gradually accumulates with age, particularly in the bones, aorta and brain. These just happen to be three areas that bear the brunt of aging, in the form of osteoporosis, arteriosclerosis, and Alzheimer’s disease. Fluoride has been shown to advance the aging process in all three areas!




No time for accumulation in the few months in utero; but fluoride affects the developing fetus adversely. Spina bifida was studied in two groups of 5 to 12 year old children, living in high fluoride areas of India with 4.5 and 8.5 parts per million of fluoride. All the children had fluorosis, either mottled teeth or skeletal pain. Compared to a control group of matched children from a low fluoride area (1.5 parts per million) the high fluoride children had almost four times more spina bifida defects (44 percent vs 12 percent).[iii] Consider the fact that the World Health Organization permissible limit is 1.5; while the United States EPA (Environmental Protection Agency) equivalent is 4.0 parts per million.

Decreased birth rates have long been observed in association with fluoridation. For example, in cattle subjected to fluoridated water at only 5 parts per million and for only four breeding seasons, the rate of births dropped to 30 percent of normal. Fluoride crosses the placenta and causes both fetal death and damage to the placenta. Thus various laboratory studies at low exposure levels have found low birth weight, delayed fetal skeletal development and delayed postnatal development in animals.  Only recently, however, has the work been extended to humans.[iv]

Dr. Freni reviewed birth rates in counties with fluoride levels above 3 parts per million. The annual total fertility rate for women age 10-49 was calculated for the period 1970-1988 in 30 regions spread out over nine states. Most regions showed an association of decreasing fertility with increasing fluoride levels. This was statistically very significant, with only a 0.0002 probability (2 in 10 thousand) of occurring by chance.


2.  BONE

Fluoride accumulates in bone more than any other tissue. Children normally have negligible amounts but over a lifetime, in fluoridated areas, this increases dramatically, up to several thousands of micrograms per gram of bone in adults. There is evidence that up to about1200 micrograms per gram is optimal, based on actual measurements of bone strength.[v] This amount of fluoride is found in normal adults in areas where water contains 0.5 parts per million fluoride,.[vi] We can expect considerably more accumulation of fluoride in our bones here in California now that our water is to be fluoridated at 1 part per million.

A very recent study in two dozen elderly women treated with fluoride for osteoporosis and vertebral fracture[vii]. found a 50 percent loss of bone strength and a huge increase in bone fluoride content after 5 years. Until 1988 there were still some advocates for sodium fluoride therapy at doses up to 80 mg per day (containing 35 mg fluoride), ie. about 8 times more than the expected intake in fluoridated areas. Despite the increased hip fractures and stomach irritation from fluoride therapy, even when offset by vitamin D and calcium supplements, the bone doctors had claimed good results and without adverse consequences. That made it difficult to persuade anyone that water fluoridation at only 1 ppm might be unsafe.

All that has changed in the past several years due to a number of research reports that document significant increases in hip fractures in elderly men and women. I am most impressed by a study of 3777 French men and women, who had lived in their respective rural parishes for an average of 41 years. In comparing those ingesting less than 0.11 parts per million fluoride to those above that and up to 1.83 parts per million, there was an almost double incidence of hip fracture above 0.11 parts per million. What stands out is the fact that low levels of fluoride, only a tenth of the amount in fluoridated California water, when ingested over a lifetime, may be more hazardous than anyone knew.

It really shouldn’t be such a surprise. A careful research of copper, manganese and zinc levels in rats on fluoridated water at zero, 10 or 25 parts per million found the copper levels in bone reduced by almost half after only ten months intake of the high fluoridated water.[viii] The authors remarked that “if sufficient copper is not available to bone, the cross-linking of bone collagen is impaired due to reduced activity of the enzyme, lysyl oxidase..” This highlights the fact that osteoporosis is not due to deficiency of calcium alone, but also other minerals, particularly copper. And fluoride may aggravate osteoporosis, not only by direct toxic effects on bone cells that manufacture collagen, but also by binding and depleting bone copper and other minerals that participate in collagen synthesis and mineralization.

I testified against AB 733, the fluoridation bill, at the California Assembly in June 1995 and I also spoke with a number of the legislators individually. They found it hard to believe that their experts and advisors could be wrong about fluoride.  Some actually requested that we not discuss any scientific data because they would only hear rebuttal from the proponents. In other words, they asked me to not confuse them with the facts! There was a snicker when Dr. John Yiamouyiannis, a world authority on fluoridation, testified that he had to invoke the Freedom of Information Act in order to get access to government data on fluoride. The legislators seemed to have their minds made up in advance. But who are they going to believe, a citizens group or the medical-dental-governmental health establishment?

Jackie Speier went so far as to challenge the validity of a recent research study, published in the Journal of the American Medical Association. This study by Drs. Danielson, Lyon and others in 1992 reported a double rate of hip fracture in men over age 80 and women over age 75, in association with a 20 year exposure to fluoride in drinking water at just 1 part per million.[ix]

Ms. Speier had said: “if you read the study in its entirety, the authors freely admit to looking at no other risk factors and, in fact relied solely on hospital discharge data.” Dr. Lyon was so offended by this that he wrote a letter to the Chairman of the Senate Appropriations Committee: “Ms. Speier’s statement that we examined no other risk factors is in error...Our study was prompted by increased risk of hip fractures observed in patients treated for osteoporosis with higher doses...of fluoride...We wondered if the same effect might be seen at fluoride levels introduced into the public drinking water...That we found an association was a surprise to us all. This association has been replicated by a group in France in a much larger population. This raises the question of an unintended side effect to fluoridating public water supplies. Our group still stands by its conclusion..”

The cost of a doubled rate of hip fracture is substantial.[x] American women over age 45 years are currently suffering over 250,000 such injuries per year and functional impairment affects 90 percent of the cases and with medical costs of almost 4 billion dollars per year! Worse yet one in four of those injured by hip fracture dies as a result. If fluoride really does account for half of all that misery and expense, isn’t that sufficient reason to stop fluoridation and seek a less dangerous way to improve dental health?



A study of 687 Downs (retarded) children found a double risk of this genetic defect in communities with 1 part per million water fluoride. Statistical analysis posits a probability of less than 1 in 125,000 that the observation was due to chance.  The average age of the mothers of these children was over 3 years less in the higher fluoride areas. A later study of 148 cases found almost three times more Down’s cases in 12 cities with water fluoride at 1 to 2.6 parts per million as compared to 15 cities free of fluoride. The age of the mothers was lower in the high fluoride cities, so the damage was not due to age.

A Harvard team found behavior changes related to sex and age at exposure in fetal rats. Males were most sensitive if exposed 17 to 19 days before birth; females were more sensitive at weaning. The severity of behavioral effects, such as decreased attention, grooming and movement was directly related to fluoride concentrations in specific brain regions.  The blood levels measured in these laboratory animals (0.059 to 0.640) are similar to those in humans exposed to 5-10 parts per million fluoride in drinking water, not much more than many humans consume. The team concluded that fluoride may cause learning disability, lowered intelligence and motor impairment.[xi]

Lowered intelligence was observed in people living in areas of China where medium or severe fluorosis[xii] is common.  Another short report from China referred to neurologic effects from fluoride: “We have seen some patients with high body fluoride levels and unclassified nervous lesion of unknown aetiology.  After removal from the higher fluoride exposure, fluoride in their body fluid decreased and their symptoms improved[xiii].

In another paper they found lower levels of fluoride in the cerebrospinal fluid than in blood.[xiv] This suggests activity of a mechanism that keeps excess fluoride from entering the brain.  However, we know that fluoride ion readily combines with three aluminum ions, producing aluminum fluoride, a potent mimic of G proteins, which regulate nerve cell activity, particularly in opiate and other neurotransmitter receptors, and in the hypothalamus. Thus fluoride interacts with the regulation of pain, mood and nerve activity in general. Could this explain the increased rate of Alzheimer’s dementia that seems to be epidemic now?

A recent poster report at the Society for Neuroscience reported on the work of Drs. Varner, Isaacson and others with sodium and aluminum fluorides in rats. Both agents caused damage to the brain hippocampal formations (memory), but the aluminum fluoride group showed more impairment. This confirms the fact that aluminum fluoride is more toxic to the brain than fluoride alone; however amyloid deposits, characteristic of Alzheimer’s and other nerve degenerations, were found in the integrative centers of the thalamus in both groups.




Fluoride and aluminum have a biological influence on nerve cells, as we have just seen. They also have a chemical interaction with each other that magnifies their activity. Researchers in Sri Lanka conducted an experiment to determine the rate of leaching of aluminum from cooking pots[xv]. The presence of fluoride at only 1 part per million, when combined with mild acids, pH 3, about the same as vinegar, liberated nearly 200 parts per million of aluminum in 10 minutes. In the absence of fluoride the pot released only 0.2 parts per million, ie. 1000 times less. Prolonged boiling produced a concentration of 600 parts per million, 3000 times more than control level. A couple of tablespoonfuls of tomatoes were sufficiently acid to increase the aluminum in a cup of fluoridated water to 150 parts per million in just 10 minutes. Kitchen fluoride reactions, with fruit compote, soups made with vinegar, and coffee, all dramatically increase both fluoride and aluminum availability. Does fluoridation of water contribute to the epidemic of Alzheimer’s and senility that we are now experiencing? If we must ask the question, we shouldn’t be adding fluoride to our water.

Enzymes are regulators of chemical reactions in living cells. A number of enzymes are disabled by fluoride at very low concentrations, less than 1 mg per liter (1 part per million) of tissue fluid or blood. For example, cell membrane energy transport relies on ATPase, which is inhibited at fluoride concentrations as low as 0.2 ppm. Other phosphatases, which regulate the release of energy from sugars and fats, are also inhibited in the presence of low levels of fluoride. Other enzymes, such as DNA repair enzymes (prevent aging and cancer), Glutamine synthetase (vital for removal of ammonia from tissues), and Acetyl-cholinesterase (to dispose of used neuro-transmitters at the synapse) are all impaired by fluoride at less than 1 part per million concentration. Blood levels of fluoride are commonly over 0.5 parts per million and other tissues even higher: kidney w.e, lung 2.1, thyroid 4.0, pancreas 1.7, brain 1.5 and bone, of course, up into the thousands of parts per million.

I warned of the enzyme-inhibiting effects of fluoride before hearings of the Environmental Protection Agency in 1984 but was unprepared to rebut when the EPA expert claimed that tissue levels of fluoride were far too low to have an effect. I should have known better because I was aware of a double blind study in humans that clearly demonstrated enzyme inhibition by fluoride at 1 ppm, the amount in California water. Dr. John Lee measured the serum bilirubin levels in his patients with Gilbert’s Syndrome, a mild jaundice due to hereditary weakness in the enzyme, UDP glucuronysyl transferase.[xvi] The weakened enzyme falls behind in the task of solubilizing bilirubin for excretion in the bile. Fluoride inhibits the enzyme further and thus causes a significant back-log of unexcreted bilirubin within two weeks of regular intake of fluoridated water. When fluoridated water is discontinued the enzyme activity improves, bilirubin excretion increases and the level of bilirubin in the blood goes back down.[xvii]

How does fluoride inhibit enzymes? It is tempting to think that it reacts with metal catalysts, such as manganese, magnesium and selenium, and perhaps this is part of the answer. But it has only been recognized since 1981, 35 years after the beginning of fluoridation, that fluoride forms a very strong bond with the hydrogen atoms of proteins and nucleic acids.[xviii] This type of chemical reaction enables fluoride to alter the shape of many enzymes, which are made from proteins; and it leads also to fluoride bonding with hydrogen bonds of nucleic acids, thus damaging the structure of DNA, the gene material. If the gene repair enzymes are efficient, the damage is almost instantly repaired. However fluoride interferes with these enzymes also, which further increases the likelihood of genetic damage and cancer.

Here is where ‘A’ for accumulation of fluoride is especially important. In 1939, before fluoridation, human tissue fluoride levels were below 1 PPM. By 1965 they had risen to 1.5 PPM in brain and in 1983 the medulla and midbrain were measured over 10 PPM[xix], more than sufficient to disrupt the biochemistry and vitality of the nerve cells. Of course, bone cells accumulate up to a thousand times more fluoride and that is why they are so much more vulnerable to the cancer causing effect of fluoride.


© 2010 Richard A. Kunin, M.D.

[i] Surgeon General Koop, Research America, The Scientist, Nov. 12, 1990.

[ii] Brunelle JA, Carlos JP; Recent trends in dental caries in US children and the effect of water fluoridation.  1990, J DENT RES, 69: 723-727.

[iii] Gupta SK, Gupta RC et al.  increased incidence of spina bifida occulta in fluorosis prone areas.  1995; Acta Paediatrica Japonica, 37(4):503-6.

[iv] Freni SC: Exposure to high fluoride concentrations in drinking water is associated with decreased birth rates.  1994; J of Tox and Env Health, 42:109-121.

[v] Turner CH, Akhter MP, Heaney RP: The effect of fluoridated water on bone strength.  1992; J Orthop Res 10:581-587.

[vi] Richards A, Mosekilde L, Sogaard CH: Normal age-related changes in fluoride content of vertebral trabecular bone--Relation to bone quality.  19194; Bone, 15:21-26.

[vii] Sogaard CH, Mosekilde Li, Richards A, Mosekilde Le: Marked decrease in trabecular bone quality after five years of sodium fluoride therapy--assessed by biomechanical testing of iliac crest bone biopsies in osteoporotic patients.  1994, Bone, 15 (4):393-399.

[viii] Singh M and Kanwar KC.  Effect of fluoride on copper, manganese and zinc in bone and kidney.  1981, Bull Environ Contam Toxicol, 26: 428-431.

[ix] Danielson C, Lyon JL, Egger ME, Goodenough J; ;Hip fractures and fluoridation in Utah’s elderly population.  1995, JAMA, 268:773-748.

[x] Chrischilles E, Shireman T, Wallace R.  costs and health effects of osteoporotic fractures.  1994, Bone 15 (4) 377-386.

[xi] Mullenix PJ, Denbesten PK et al.  Neurotoxicity of sodium fluoride in rats.  1995, Neurotox and Teratol, 17:169-177.

[xii] Li J, Zhi L, Gao RO.  Effect of fluoride exposure on intelligence in children.  1995, Fluoride (28)189-192.

[xiii] Hu Yu-huan.  Direct damage on nervous system by fluorosis.  1982, First Conference on Neuropsychiatric Diseases in Xinjian. 86-8.

[xiv] Hu Yuu-Huan, Wu Si-Shung; Fluoride in Cerebrospinal fluid of patients with fluorosis. 1988, J of Neurol, Neurosurg, and Psychiatry, 51:1591-1593.

[xv] Tennakone K, Wickramanayake, S.  Aluminium leaching from cooking utensils; 1987, Nature, 325:2092.

[xvi] Bosma PJ, Chowdhury JR et al: The genetic basis of the reduced expression of bilirubin UDP-glucuronosyltransferase 1 in Gilbert’s Syndrome. 1995,  NEJM  333:1171-5

[xvii] Lee J: Gilbert’s disease and fluoride intake.  1983, Floride 16:139-45.

[xviii] Emsley J: Fluoride forms hydrogen bonds.

[xix] Chan AWK, Minski MJ, Lai JCK: An application of neutron activation analysis to small biological samples: simultaneous determination of thirty elements in rat brain regions.  1983; J of Neurosci Methods, 7: 317-328.