The dangers of salt fluoridation in Lebanon

Not all salt is created equal. However, if the new law on salt fluoridation in Lebanon sees light, not only will all salt in this country be equal but it will pose a public health threat and we won’t be able to do anything about it.

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Photo credit planet-science.com

When you hear the word fluoride, dental caries and toothpaste inevitably come to mind; and that’s for a good reason. Fluoride, a mineral, has been shown to prevent dental caries and protect our teeth at the right dose. The right dose is the keyword here. After all, fluoride is a micronutrient; meaning it’s only needed in very minimal doses and any consumption beyond that limit will have undesirable and dangerous side effects on adults and even more so on children.

Let’s start first by discussing fluoride, its tolerable doses and its sources in nature before attempting any talk about all the recent studies condemning this “medicine” that we are blindly going to add to our salt.

Fluoride is one of the most abundant elements in the Earth’s crust. In water and toothpastes, it exists in the form of sodium fluoride.

The National Institute of Health recommends the following intakes of fluoride noting that topical use of fluoride may provide better results than its ingestion.

infants 0 – 6 months, 0.1 mg ( even though other sources state there is no need for fluoride intake before 6 months of age)
infants 7 -12 months, 0.5 mg
children 1 – 3 years, 0.7 mg
children 4 -8 years, 1 mg
children/young teens 9 -13 years, 2 mg
teens 14 – 18 years, 3 mg.
Female adults, 3 mg
Male adults, 4mg

Fluoride is found in fish and fishbones (canned sardines and salmon included), in tea and in drinking water. The levels in drinking water differ depending on the ground-source with some areas having naturally more fluoride than others.

Water fluoridation started in the 1940s as a means to combat dental caries and improve oral health in communities where fluoride in water was low. Decades later, this practice is no longer necessary or at least not in the amounts previously used because the consumption of fluoride from other sources has increased. We now have fluoridated toothpastes, gels, mouthwashes, varnishes…

According to the World Health Organization, the toxic side effects of excess fluoride are due to the fact that it is a “direct cellular poison“. These adverse effects are the following:

1- It binds calcium and interferes with the work of certain enzymes.
2- It reacts with gastric juices causing abdominal pain, excessive salivation, nausea and vomiting if consumed in high concentration. Muscle spasms can also occur as well as death due to respiratory paralysis.
3- Long term ingestion of high doses of fluoride is known as fluorosis. We distinguish two types:
a- Enamel fluorosis in children. It is characterized by white spots on the teeth. This is merely an aesthetic issue, however, severe cases suffer from stained and chipped teeth.
b- Skeletal fluorosis is when fluoride accumulates in the bones over a number of years. It starts with stiffness and pain in the joints, progressing to calcification of tendons and ligaments, and bone deformities.

Dental and skeletal fluorosis cases are not uncommon. Excess fluoride concentrations in water have caused tens of millions of cases world-wide over the years as reported by the World Health Organization.

More recent studies and meta-analyses have shown that children living in high-fluoride areas had significantly lower IQ scores ( lower by 7 points on average) than those who live in low-fluoride areas.

Another review discussed the evidence showing the damage that fluoride can cause to the central nervous system. Much like aluminum and lead other neurotoxic metals, fluoride can cause injury to the nervous system through excitotoxic mechanisms.

Let me talk now a bit about the medium they’re going to use. SALT.

Our country’s numbers regarding salt consumption are not at all promising. We consume salt and we consume it in excess. According to a recent study, over 680 yearly deaths have been recorded in Lebanon as a result of excessive salt intake. Salt intake in Lebanon is not only due to the excess consumption of table salt at home. Most people are unaware that they are consuming it in breads, in labneh, in local cheeses, in baked goods notably our man’ousheh, and in much more hidden sources. The recommendations following that study was that Lebanon is in need of a salt awareness campaign. So, as a consumer, will you be confused much as to why we need to reduce our salt consumption but then we are going add to it fluoride which is supposedly a “healthy and needed” element? I know I am.

For our special case about mandatory salt fluoridation in Lebanon, I contacted Dr. Omar Obeid to ask him about his valuable professional input. Dr. Obeid is a nutrition professor at the American University of Beirut. His research interests have focused on micronutrients in health and disease and hepatic metabolism among others.

According to Dr. Obeid, even though water content of fluoride in Lebanon is low and the rate of dental caries is high, we do not have a good system to control the fluoridation of salt. . He also voiced his concern with the risks associated with high fluoride intake. What’s even more specific to our population is that a large percentage drinks tea on a regular basis and tea has high levels of fluoride. So with this law, we are putting tea drinkers at high risk of fluorosis and low IQ.

When it comes to kids, Dr. Obeid worries that a lot of toothpastes are fluoridated and children ingest a large percentage (more than 50%) of it during brushing.
Not to mention the wide availability of fluoride tablets in the market. So a child consuming fluoridated salt, drinking tea, and brushing with fluoridated toothpaste would probably be consuming more than they need and will again be putting themselves at risk. That and we’re not taking into consideration the potential ingestion of fluoride tablets.

Reduction of dental caries depends on several factors, mainly proper dental hygiene ( brushing, flossing, and regular checkups). Some studies even show that fluoridation alone ( water or salt) was not able to affect oral health without the implementation of proper dental hygiene practices. So reduction in oral decay is highly dependent on proper dental hygiene.

It’s necessary for me to mention here too the importance of a balanced diet. A recent review regarding sugar consumption, dental health and fluoride showed that we need to reduce our kids’ sugar intake to less than 2-3% per day as opposed to the current guidelines of <10% regardless whether fluoride intake is optimum or not. Yet another study marginalizing the importance of fluoride. Can we see a national public campaign raising awareness on the dangers of sugars before attempting a national salt fluoridation program?

Moreover, Dr. Obeid continues children do not need fluoride before developing their permanent teeth. Using (fluoridated) mouthwash (once per week)seems to be a good way for the handling of dental decay, even though a proportion is ingested. The ministry of education in Lebanon has implemented this program for all public schools. Dr. Obeid asks: “Are we going to stop this program? Did we evaluate the impact of this program before moving into another one?”

We leave these questions to the people responsible in the ministry of public health to answer.

Meanwhile, let’s make them hear our concerns. Yasmine, the activist behind the Facebook group, Consumer Protection For Healthy Food in Lebanon (and elsewhere) has started an online petition opposing the law. Please click on this link , ( https://secure.avaaz.org/en/petition/The_Lebanese_Ministry_of_Health_Stop_fluoridation_in_water_and_salt_in_Lebanon/?nFVvbab ) sign and share.

A friend asked me if they will listen. Well, we’ll have to roar and see.

Note: Dr. Obeid has conducted a study on urinary fluoride excretion among elementary school children in Lebanon (about 1400 students) with data to be available soon. I suppose any law of fluoride fortification should not take effect without at least looking more into research like this one.

Note2: There is already in the Lebanese market fluoridated salt imported from France ( trademark; La Baleine; potassium fluoride 250mg/kg). Some dentists recommend its use provided that the children aren’t given any other fluoride supplementation. Can we say that for the whole population when all salt is obligatorily fluoridated?

Note3: In few European countries, salt fluoridation exists, however it is not mandatory. So, if people choose not to use tablets and use salt, it’s up to them and vice versa. Plus, it is forbidden to be used in public food places. So, if you’re eating at a restaurant, you know for sure your salt is not fluoridated. The problem in Lebanon is that we won’t. All salt will be fluoridated, whether at home, in restaurants or in the food industry in general.

References and Further readings:

http://www.ncbi.nlm.nih.gov/pmc/?term=10.1289/ehp.1104912

http://lm.facebook.com/l.php?u=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3D19WCTO9GJQQ%26t%3D17m13s&h=OAQHLpxKq&enc=AZNR_su5ddNfV7Ha0JWtx5uE6Zuqsp5sQBDQNN12WiEB90Rqbjx2fZb2ykgaYw7B0ReaWbb-bTC9NgmwwwxRNBz4&s=1

http://www.who.int/ipcs/assessment/public_health/fluoride/en/

http://www.who.int/ipcs/features/fluoride.pdf?ua=1

http://m.huffpost.com/us/entry/2479833

http://www.aub.edu.lb/fm/vmp/media/Documents/pdf/LASH-media-2014.pdf

http://tamar.tau.ac.il/~eshel/Bio_complexity/8.Human%20Brain/Autism-Mitochondria-mercury.pdf

http://mobile.assafir.com/Article/13/375357

http://www.aubmc.org/Pages/Latest-LASH-research.aspx#sthash.WMpKcC8y.dpbs

http://fluoridealert.org/studies/acute03/

http://fluoride.mercola.com

https://secure.avaaz.org/en/petition/The_Lebanese_Ministry_of_Health_Stop_fluoridation_in_water_and_salt_in_Lebanon/?nFVvbab

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