Archives : 2012 : August
It seems that recently more attention has been given to fluoride in drinking water and whether or not this element is healthy or harmful. A brief overview of fluoride as well as the pros and cons of water fluoridation are discussed below.
Overview: What is Fluoride?
Fluoride can occur naturally in drinking water and most drinking water supplies consist at least partly of naturally-occurring fluoride. Industries, such as aluminum or fertilizer factories may also contribute to fluoride levels in the drinking water. Most commonly community water systems fortify drinking water by adding fluoride but occasionally the natural levels are too high and water systems must actually decrease the level. The process in which the fluoride levels are adjusted is called community water fluoridation. Though many people are not aware, water fluoridation has been in existence for 67 years since the city of Grand Rapids, Michigan began adding fluoride to municipal water in 1945.
In the early 1900s, dental scientists discovered that in areas where the drinking water contained higher levels of fluoride, residents experienced less tooth decay. After further research it was determined that fluoride in the water helps to prevent tooth decay by preventing de-mineralization, which occurs when acid produced by bacteria in the mouth removes minerals in the tooth. Fluoride also helps to re-mineralize the tooth as well. The potential benefits of community water fluoridation spurred a rapid adoption of this method throughout the country. The Centers for Disease Control (CDC) reported that as of 2010, approximately 73% of the public drinking water systems in the U.S. are optimally fluoridated. Fluoridation is not federally mandated but instead is decided upon by the state or local municipality.
According to the American Dental Association (ADA), the U.S. Public Health Service originally determined that the optimal fluoride level in drinking water is between 0.7 to 1.2 parts per million (ppm). More recently, however, in 2011, the Department of Health and Human Services recommended that the optimal level be reduced to simply 0.7 ppm.
The Pros of Drinking Fluoridated Water
Fluoridation of community water systems is deemed by the CDC to be one of the 10 greatest public health achievements of the 20th century. The ADA also supports fluoridation and mentions that the concept of fortifying water with fluoride is very similar to fortifying milk with Vitamin D or cereal with Folic Acid. When you drink fluoridated water, the fluoride becomes concentrated in the dental plaque which helps prevent breakdown by acid. Fluoride also re-mineralizes the tooth by first attaching or “adsorbing” to the tooth which then attracts calcium molecules and aids in chemical reactions which produce a crystal surface that is more resistant to acid.
By drinking optimally fluoridated water, you can potentially reduce tooth decay in your lifetime by approximately 25%. Water fluoridation is also viewed as an inexpensive process particularly in larger communities, costing approximately 50 cents per person in communities larger than 200,000 people. The ADA also mentions that one dollar spent on fluoridation saves 38 dollars in dental treatments for tooth decay. Another benefit of community water fluoridation is the availability of fluoride delivery to all income levels. Individuals that cannot afford routine dental care do not have to purchase products such as fluoridated toothpaste or fluoride supplements to receive the benefits of fluoridation.
The Cons of Drinking Fluoridated Water
While drinking optimally fluoridated water reduces tooth decay, higher levels of fluoride can cause negative or undesirable effects. The EPA determined that the maximum contaminant level goal (MCLG) for fluoride in drinking water is 4.0 ppm. Consistent lifetime exposure to 4.0ppm or higher fluoride levels can increase the likelihood of developing a condition called skeletal fluorosis which involves bone pain and tenderness in adults. Lifetime exposures to high levels can also increase the likelihood of bone fractures in adults. This MCLG is regulated by the EPA.
The EPA also established a secondary maximum contaminant level (SMCL) of 2.0 ppm for fluoride in drinking water. EPA cannot require that water systems remain under this level but both the EPA and CDC highly recommend remaining below 2.0 ppm to avoid cosmetic effects. Children aged 8 years and younger that are consistently exposed to fluoride levels of 2.0 ppm or higher can develop dental fluorosis which is a change in the appearance of the tooth enamel. Only this age group is at risk because fluoride only affects permanent teeth while they are still developing in the gums. The fluoride can disrupt enamel maturation which causes enamel porosity. The fluorosis can be mild where the teeth have white flecks or spots, frosty edges, or fine lines. More severe forms of fluorosis can result in rough, pitted, or stained teeth. The severity of the fluorosis depends on the amount of fluoride in the water, the duration of exposure (days vs. years), and the susceptibility of the child.
Dental Fluorosis: Increased Risk in Infants
Infants up to the age of 12 months may have a slightly greater risk of dental fluorosis if their main source of nutrition is powdered or liquid infant formula that is reconstituted with fluoridated water. Infant formulas already contain fluoride and the level increases with the addition of fluoridated water. For example, the ADA reported that when water containing 1.0 ppm fluoride is added to a powdered soy-based formula the average concentration of fluoride is 1.07 ppm. Powdered formulas that are either milk or soy-based have the highest fluoride levels while liquid formulas are slightly lower. The levels may be higher if the water used has fluoride levels greater than 1.0 ppm. If your infant is regularly consuming reconstituted infant formula and you are concerned about the risk of fluorosis, you can use ready-to-feed formulas, which have much lower fluoride levels, approximately 0.15 ppm in milk-based and 0.21 ppm in soy-based. Another option is to reconstitute the powdered and liquid formulas with filtered or purified water that either has low concentrations of fluoride or is fluoride-free.
How much fluoride is in your water?
If you would like to know the level of fluoride in your community water system, go to the CDC website titled My Water’s Fluoride, and search for your water district by state and county, or water system ID or name. You can also request a Consumer Confidence Report from your local water supplier. Since fluoride can be naturally-occurring, well water may likely contain fluoride as well. In fact, in 2008 the U.S. Geological Survey reported that 4% of sampled wells had fluoride levels above 2.0 ppm. The EPA recommends that well water should be analyzed by a laboratory every three years.
If you are concerned about drinking fluoridated water, either from the tap or well, you should consider purchasing a water filter that will reduce the fluoride levels.
Recent events in Washington D.C. have caused the long-forgotten yet tragic Camp Lejeune water contamination event to re-surface. Though unknown to many Americans, the water contamination at two treatment plants at the U.S. Marine Corps Base Camp Lejeune in North Carolina was a serious contamination problem that spanned three decades and caused illness in hundreds of thousands of Marine veterans and their families. Though the water contamination occurred between 1957 and 1987, President Obama just recently signed a bill that provides health care to the more than 750,000 marine veterans and their families that were affected by the contaminated water. It is important that we learn exactly what happened at Camp Lejeune in order to fully understand the consequences of drinking contaminated water.
Drinking Water Contaminants
According to the Agency for Toxic Substances and Disease Registry (ATSDR), two of eight water treatment plants at Camp Lejeune were found to be contaminated in a 1982 study. The Tarawa Terrace Treatment Plant was contaminated with perchloroethylene (PCE), also known as tetrachloroethylene, which was released by an off-base dry cleaning firm. For thirty years, the PCE exceeded the limit of 5 parts per billion (ppb) with maximum levels at approximately 215 ppb.
The other polluted treatment plant was Hadnot Point. Leaking underground storage tanks, waste disposal sites, and industrial area spills released trichloroethylene (TCE) as well as other contaminants into the drinking water near this site. Though the maximum contaminant limit for TCE is only 5 ppb, the maximum TCE level detected in the drinking water when tested in 1985 was 1400 ppb.
The effects of drinking water contaminated with PCE and TCE are largely unknown due to a lack of scientific studies. According to ATSDR, PCE and TCE are believed to be responsible for causing bladder cancer, breast cancer, lung cancer, rectal cancer, and leukemia in some people that lived or worked at Camp Lejeune. Pregnant women that drank the contaminated water exposed their fetuses as well, which caused low birth weight babies and in some cases, fetal death. Many children that were exposed to either PCE or TCE while still in the womb also experienced numerous health effects including:
- Eye defects
- Heart and neural tube defects
- Oral cleft defects (cleft lip)
- Chonal atresia (nasal passages blocked by bone or tissue)
The severity of the health effects varied depending on the amount of contaminant available and duration of exposure. Therefore, some people did not experience severe effects or any effects at all. But the fact that even one individual has suffered due to this extremely long period of contamination is inexcusable. Though the treatment plants were shut down in 1985, thousands of Americans still experience health problems today as a result of this event.
Unfortunately the Camp Lejeune victims cannot change what happened to them but you can learn from this incident and take steps to avoid drinking contaminated water. First of all, understand that contaminants in the water are often undetectable, producing no odor or foul taste, yet the consequences from drinking these contaminants may be severe. Secondly, be aware of any potential sources of contamination in your area, such as agricultural or industrial runoff. Thirdly, investigate the quality of your tap or well water. Finally, take control of your drinking water and use a water filter that removes harmful contaminants.
Numerous contaminants can find their way into your drinking water source whether it is a river, lake, stream, spring, reservoir or well. Industrial processes can release contaminants such as heavy metals like cadmium or mercury as well as other harmful chemicals. Pesticides and herbicides end up in the water due to agricultural and residential activities. Not all sources of contaminants are due to humans however. Microorganisms like viruses, bacteria and parasites, as well as many other contaminants like radium (a radionuclide), are naturally-occurring. All of these contaminants influence water quality.
The Safe Drinking Water Act was passed in 1974 to help protect and regulate public drinking water and limits the presence of contaminants in community water systems which are those systems that serve the same people year-round. The Environmental Protection Agency (EPA) sets and enforces water quality standards for approximately 90 contaminants in drinking water systems. For each contaminant, the EPA identifies the maximum contaminant level (MCL) allowed in drinking water as well as the maximum contaminant level goal (MCLG). Any level below the MCLG is not known to pose any risk to human health. The MCL and MCLG for each primary contaminant as well as the source and potential health effects from long-term exposure to the contaminant can be found at the EPA’s Drinking Water Contaminants page .
How can you learn what is in your tap water?
Drinking water quality can vary considerably by location due to differences in the water source as well as the treatment processes. Therefore it is very important to learn about the quality of your own drinking water as it may be quite different from that of a relative or friend who may live in the same city but uses a different water system. Your local water supplier is required to produce an annual Consumer Confidence Report by July 1st of the calendar year and you can contact the supplier directly or visit their website (if available) for this report. Also, the EPA posts some Consumer Confidence Reports online and provides the database, Drinking Water Watch. This searchable database consists of information provided by state agencies regarding drinking water quality for 17 states.
Everyone should learn about the quality of their drinking water. It is especially important for immune-compromised individuals to understand their drinking water quality. These individuals include pregnant women, elderly adults, transplant patients, those with HIV/AIDS, and individuals receiving chemotherapy. If you are in one of these categories, the EPA advises discussing your drinking water quality with your physician because you may be more susceptible to contaminants. For example, according to the EPA, Cryptosporidium (a microscopic parasite) can pass through the filtration and disinfection processes, though this is an extremely rare occurrence. Healthy individuals will not likely experience any symptoms but if you are immune-compromised, you may experience severe or even fatal symptoms. Any individual, healthy or immune-compromised, can take additional precautions by filtering their drinking water with a water purifier that is proven to remove chemical contaminants as well as bacteria, parasites, and cysts from the water.
If nutrition and fitness are an important part of your daily life, adding plenty of fresh, clean drinking water to your diet can have many positive health benefits. According to the Mayo Clinic, water is necessary for the body to perform its most basic functions such as body temperature regulation and nutrient/ oxygen transport via the circulatory system. Water is also needed to protect tissues, organs, and the spinal cord as well as maintain moist membranes found in your eyes, nose, and mouth. Water aids in toxin removal by dissolving uric acid, urea, and lactic acid, which are all waste products that can be harmful if they persist in the body. By drinking water you are reducing the burden on your kidneys and liver which remove these potential toxins from the body.
Improved digestion is another important benefit of drinking water. By combining with enzymes in saliva, water dissolves nutrients and soluble fiber which makes these items more available for your body to absorb and process. Water also improves digestive health by helping to relieve and prevent constipation. Water is not only necessary for proper digestion but is also a component of the synovial fluid that lubricates and cushions joints. By drinking water, you can possibly reduce the severity of sprains and injuries.
In addition to the basic health benefits, drinking water can be incorporated into your diet to help lose weight. The CDC suggests substituting sugar- sweetened beverages with water. You will consume approximately 240 fewer calories by drinking 20 ounces (oz.) of water in place of a 20 oz. soda sweetened with sugar. Furthermore, an obesity study funded by the Institute for Public Health and Water Research also suggests that when combined with a low calorie diet, drinking approximately 16 oz. of water prior to every meal can lead to greater weight loss in middle-aged and older adults, partly because the water causes increasing fullness and consequently not as much food is consumed.
How much water should you drink?
Water is lost during the normal processes of perspiration, respiration, and excretion. During daily activities and short bouts of exercise, a person will lose between 1.5 and 3 cups of water through perspiration alone so it is important to remain well-hydrated. There are many different suggestions of average daily water intake. The Mayo Clinic reports that the Institute of Medicine recommends that males drink 13 cups per day while females should drink 9 cups per day. The CDC says that normally active people should drink at least 2 quarts per day. Other sources suggest that to determine your specific daily water intake in ounces, you should divide your body weight (pounds) by 2. For example, a 120 lb individual should drink 60 oz. of water per day (120 lbs/2 = 60 oz.). Remember, factors like intense exercise (running a marathon), hot climates, or illness that includes high fever, diarrhea, or vomiting will cause more water loss and require that you drink more water to avoid dehydration.
Clearly water is essential to maintaining good health so start drinking more water and experience the many health benefits today!