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Early pregnancy nutrients - fluoride. By Ray Grogan
Explanation of the "doses in perspective" chart













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I apologize for the lousy graphics in the table below. It probably has WAY more info about doses than you need. But if you're looking at the chart with all the dose info, and you want to see what was meant by some cryptic remark like "No birth defects observed", you can get the details here.

 

Explanation of the chart "Daily doses of fluoride in perspective"

Dose in mg F

Short version shown on chart

Longer explanation, reference, etc.

 

20

No birth defects observed

 

Although the evidence is far from conclusive, it appears that humans can tolerate high doses of fluoride in early pregnancy without causing a noticeable increase in birth defects. There are places with ultra high fluoride naturally in the drinking water. Here pregnant women get a daily average fluoride intake of about 20 mg F, with no known problems with birth defects. (Teotia 1979, Fluoride 12(2):58.)

(See even longer note below the table.)

10

Highest sug prevent osteoporosis

After preventing cavities, the second most popular (but relatively rare) use of fluoride is in the prevention of a bone disease, osteoporosis. There is not much to go on for evidence. The highest amount of fluoride I have seen suggested is 10 mg F per day, for people 8-25 years old, for the prevention of osteoporosis. (Dustin 1970, Fluoride in Medicine, TL Visher, ed, page 185. This suggestion was rejected on page 192. A more reasonable approach is about 1 mg F per day to prevent osteoporosis. See Osteoporosis, Mayes 1986, page 64.)

10

Highest in any circumstances

This is just my generalized highest recommendation. (For my patent application I had to put a lid on it somewhere.)

6.4

Threshold of fluorosis scale infant

This is taking a fairly well known value from infant studies, and scaling it up to a 140-pound woman. (The infant dose that starts causing fluorosis, in about 20% of cases, is .1 mg / kg.)

4

Pushing fluorosis PNF (my opinion)

This is just my opinion of what dosage might start to cause fluorosis (white spots on teeth) if taken in pregnancy. (The permanent front teeth start forming at about month 7, and from that time forward I would make no sudden increases of greater than .5 mg per day.)

4

NAS high end safe and adequate

(see just below)

4

NAS est F intake F H2O

The adult intake of fluoride considered to be "safe and adequate" by the National Academy of Sciences is from 1.5 to 4.0 mg F per day. This range is not reached by adults in non-fluoridated areas, where the estimate on fluoride intake is about 1.0 mg F per day. This range is said to be easily met in fluoridated areas, where the estimated intake is about 4.0 mg F. (1980 RDAs, page 156.) (This would be 16 glasses of water, though, so I think they're off.)

3.1

IOM - Adequate intake pregnancy

The first quasi-official recommendation specifically for pregnancy. The AI (adequate daily intake, which is the lower limit, for F from all sources) for pregnancy has been set at 3.1 mg F. (Institute of Medicine, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, 1997.)

2.1

Optimum .033/mg/kg scaled fr infant

This is another case of scaling up from infant values to 140 pounds. This dose is equivalent to what I say is best for infant teeth.

2

High risk, regular E/D, no F H2O

My recommendation for early pregnancy for HIGH-risk parents who are regular eaters / drinkers, and who do NOT have fluoridated water. (Please see dosage table).

2

Somer rec for early pregnancy PNF

A prominent expert on women's health and nutrition has recommended 2 mg F in the section of her book about early pregnancy. (Somer E.  Nutrition for a healthy pregnancy.  H. Holt & Co. 1995.)

2

Glenn's more recent PNF dose

Frances B. Glenn, DDS is by far and away the planet's best authority on prenatal fluoride. She just published an excellent and entertaining book: How to have children with perfect teeth, Glenn FB 2000.

1.5

NAS low end of safe and adequate

(see NAS above at 4 mg)

1.25

PNF amniotic fluid levels rise

Lab work was reported that showed how much fluoride a mother has to take to have some leftovers appear in the amniotic fluid. (To get to the amniotic fluid fluoride has to pass from the mothers blood stream to the fetus, then pass through the fetus.) The smallest dose tested (.25 mg F) was enough to show in the amniotic fluid, roughly doubling the background levels. It took at least 1.25 mg to make the levels start to rise again (implying at least partial satisfaction of both bodies). The mothers were 3 to 4 months into pregnancy at the time of the test. (Brambilla 1994, Archives of Oral Biology 39(11):991.)

1

PNF prevents over 90% of cavities

(see most common PNF dose below)

1

PNF prevents "pits and fissures"

The closest thing to an absolute defect that is absolutely prevented by fluoride is from the prenatal fluoride studies of Glenn. There is a very common defect of molar teeth, called pits and fissures. The pits and fissures of the primary molars form at about the 5th month of pregnancy and show when these teeth erupt at about 2 years. Without extra fluoride in pregnancy most children (97%) have pits and fissures to some degree on at least one tooth. Of the total individual teeth, 28% have at least one very large pit. Prenatal fluoride makes a black and white change: only 2% of children have any sign of pits and fissures, and none of the individual teeth has a large pit. (Glenn 1984, ASDC Journal of Dentistry for Children 51:19.) It was trying to understand this paper by Glenn that got me started. You can see a crude version of the biology at

http://raygrogan-ivil.tripod.com/howdoesfluoridechangetheshapeofteeth/index.html

1

PNF prevented part of a cleft lip?

The most complicated science of human nutrition is total parenteral nutrition, or TPN. In TPN doctors are 100% responsible for nutrition because every thing a patient eats comes predigested, through a tube, straight into the blood stream. TPN is used in various conditions that do not allow the use of the patients digestive tract.

There have been a few pregnancies reported during TPN. In at least a few of these pregnancies fluoride was began as soon as pregnancy was detected, including early pregnancy. In one of these the fluoride (1 mg) was began at about day 49. When the child of this pregnancy was born, it had what was thought to be partial cleft lip. That hit me like a ton of bricks, since the time the fluoride was started was right in the middle of the time cleft lips form.

If an embryo with a cleft lip beginning is aborted on day 42, the cleft lip is visible microscopically. I think in this TPN case the cleft lip may have been forming from day 42 until the fluoride was started on day 49, and that is why the child ended up with a partial cleft lip instead of a full blown one. (Unfortunately this article does not say which side of day 49 the cleft is on. I have written but not gotten an answer.) (Mughal 1987, British Journal of Obstetrics and Gynaecology  94:44.)

1

Most com sug prevent osteoporosis

(see osteoporosis above at 10 mg)

1

NAS est F intake if no F H2O

(see NAS above at 4 mg)

1

NAS 1990, Nutr Preg, adults cavities

The RDA people seem to have finally given their tacit support of fluoride in pregnancy, and even to early pregnancy in the sense that they support fluoride for adults in general: "Adults may also derive some benefit [for preventing dental caries] from a fluoridated water supply or a 1-mg fluoride supplement per day...". (National Academy of Sciences 1990. Nutrition During Pregnancy. Page 311.)

1

Most common PNF dose

See a separate table on the half-dozen studies on prenatal fluoride (PNF). In a nutshell most prevented about 90% of tooth decay in the offspring. Most used 1 mg F, and started when the baby teeth start forming about month 3. PNF is now used by about 10% of doctors. The most well known study is Glenn 1982, American Journal of Obstetrics and Gynecology 143:560.

1

4 glasses fluoridated water

A liter of fluoridated water is usually 1 ppm F, or 1 mg F. A liter contains roughly 4 8-ounce glasses of water.

1

Plain NaF tablets

Plain sodium fluoride tablets, 2.2 mg NaF, provide 1 mg F. A half tablet  will provide .5 mg F. This form of fluoride would go well with a prenatal vitamin. This is by far the most commonly prescribed fluoride supplement, used for decades by millions of children and teenagers (and thousands of pregnant women).

1

Monocal® from Mericon (available F)

Monocal® from Mericon has 3 mg F actual, but it has enough calcium to make only about 1 mg of that available. There are a few ways you can get this down to .5 mg F: taking a half pill, or taking a whole one every other day, or taking a whole one with the biggest meal of the day. There is a similar product, Florical®. These are very high-quality calcium supplements, and sell for about $13 per 100 pills. These products are sold behind the counter, meaning you dont need a prescription, but you have to ask the pharmacist for it. (Ive tried all the F products, for me, just as an adult, and Monocal is my overall favorite.)

1

Low risk, regular E/D, no F H2O

My recommendation for early pregnancy for LOW-risk parents who are regular eaters / drinkers, and who do NOT have fluoridated water. (Please see dosage table).

1

High risk, regular E/D, + F H2O

My recommendation for early pregnancy for HIGH-risk parents who are regular eaters / drinkers, and who have fluoridated water. (Please see dosage table).

 

0.7

Threshold of pos bal scale up infant

This is yet another value from infant studies scaled up to 140 pounds. This is very roughly the dosage at which an infant starts gaining fluoride (versus peeing out more than comes in, using up reserves). The studies are pretty sparse in this area, and the actual value might be about half what I chose, ie, about .005 mg / kg versus my conservative .011.

0.5

Low risk, regular E/D, + F H2O

My recommendation for early pregnancy for LOW-risk parents who are regular eaters / drinkers, and who have fluoridated water. (Please see dosage table).

0.5

Low risk, good E/D, no F H2O

My recommendation for early pregnancy for LOW-risk parents who are good eaters / drinkers, and who do NOT have fluoridated water. (Please see dosage table).

0.5

My early preg one-dose-fits-all

I chose this dosage for people and doctors who don't want to fiddle with my dosage table. It is my opinion that .5 mg F is a fine dose to use for all modern women. This will not be too much for any woman who is living in normal circumstances. A dose of .5 mg F should be enough even for someone who was getting no other sources of fluoride. However, it is not too much trouble to get a daily dose that is a little more exact. Please see dosage table.

0.5

Trinity Spgs Min Water® per 1/2 cup

Trinity Springs Mineral Water® has 3.7 mg F per liter bottle. One half cup per day would be fine.

0.5

Pediatric products for small children

After infancy, pediatricians bump up the dose to .5 mg. Many pediatric products will give the dose of fluoride (.5 mg F) and other vitamins and minerals that pediatricians use for small children.

0.5

Comm infant waters w/ F per liter

There are commercial waters made just for babies. Most, but not all, fluoride. (Beech-Nut® Spring Water with Fluoride and Hinckley Springs Nursery® Water are two brands.) These have half the fluoride of regular fluoridated water, and are perfect for use with powdered formula.

0.5

Bone Nourisher from L&H

A product called Bone Nourisher from L&H Vitamins, Inc. 1 800 221-1152 has fluoride. Three of their tablets contain 1 mg F, so 1 or 2 per day would be about .5 mg F.

0.5

A half tablet plain NaF tablets

(see NaF above at 1 mg)

0.5

8 bone meal tablets

Bone meal tablets, about 8 tablets a day, will provide the bioequivalent of a 1.1 mg NaF (.5 mg F) dose.

0.5

6 ounces canned salmon inc bones

A good source of fluoride is ocean fish, in a can and including the bones. About 170 g (6 ounces) of canned salmon a day is a delicious choice, which also provides calcium and many other important nutrients for pregnancy. (Bioequivalent dose.)

0.5

o-cal f.a.® from Pharmics

At least 1 adult vitamin-mineral product contains .5 mg F. It is o-cal f.a.® from Pharmics 1 800 456-4138. It also supplies the common prenatal nutrients, but to get the trace nutrients, you would also need a trace element mix such as Essential Minerals® from VRP 1 800 877-2447. One tablet of this (not the 3 shown on the label) will give a reasonable dose. (Another trace element mix is Right Choice® from Body Wise®, Carlsbad CA. 1 caplet. The big chain GNC® 1 877 716 6862 was one of the first businesses to promote folic acid supplements in early pregnancy, and they have at least one trace nutrient product, I think called Trace Element Mix. )

0.25

Enough to show in the amniotic fluid

(see amniotic fluid above at 1.25 mg)

0.25

8 oz glass of fluoridated water

A glass of water is roughly one fourth of a liter, and a liter of fluoridated water is roughly 1 mg F. So a glass of water is about .25 mg F.

0.25

Low risk, good E/D, + F H2O

My recommendation for early pregnancy for LOW-risk parents who are good eaters / drinkers, and who have fluoridated water. (Please see dosage table).

0.1

Lowest in any circumstances

This is just my generalized lowest recommendation. (For my patent application I had to put a bottom on it somewhere.)

0

USA standard for pregnancy (0)

There is a reason why it is highly unlikely a pregnant woman would get prenatal fluoride unless she went out of her way to ask for it. In the United States it is legal to sell fluoride for anyone except pregnant women, the very people who need it the most. You can sell fluoride for babies, adults, teenagers, lactating moms, grandmothers, women in general, but you can not say a word about pregnancy on the label of any product that contains any fluoride. It is specifically illegal to put fluoride in products like prenatal vitamins, thanks to the dental lobby, way back in 1966. To this day they refuse to allow it.

0

Dental lobby's preference (0)

The dental lobby usually sounds pro-fluoride, but they fight like tigers to keep supplementation at zero for the first year or so teeth are developing. If you would like to see some of their craftsmanship, see Leverett DH. Clinical trial of the effect of prenatal fluoride supplements in preventing dental caries. NIH-NIDR-NO1-DE-32441; April 1992. Available free of charge from: Mr. Wayne Little / Public Information and Reports Section / Room 2C35 Building 31 / National Institute of Dental Research / 9000 Rockville Pike / Bethesda, MD 20892 / (301) 496-4261. (Or see summary in Caries Research 1997; 31:174-179.) In this huge clinical trial, it was found that something like 90% of children were cavity-free if they started fluoride at either of two times, pregnancy or birth. However, the conclusion was not that EITHER starting time is fine. It was that NEITHER was OK. A few years later the same author is pushing waiting until age 3 years to begin supplements. Assessment of dental fluorosis in relation to the dosage of dietary fluoride supplements used. NIH-NIDR-NO1-DE-22593; August 1994. Prenatal fluoride remains illegal, and they managed to get pediatric recommendations to drop fluoride for the first 6 months of infancy.

0

Anti-fluoridationist's preference (0)

Anti-fluoridationists generally imply that fluoride is toxic at all times and at all doses. However, if you ask them for specific recommendations for pregnancy and infancy they sound eerily like the dental lobby.

 

More detailed notes.

 

From 20 mg per day, "No birth defects observed"

 

(References at end.) People who live in high fluoride areas have fluoride intakes that are staggeringly high. For example, Teotia shows a group of pregnant women with an average daily intake of 21 mg F, with the range going up to about 37 mg. (Equally staggering is the apparent use of fluoride by the growing fetus and/or the remodeling mother. In Teotias graphs it looks to me like these two uses clear about a fourth of the fluoride by the 6th month and over half by the 9th. There is no noticeable fluoride use in early pregnancy.)

 

Mason's review of births in these high fluoride areas did not reveal any problems as far as birth defects go. The extent of the review is simply that "birth defects have not been reported among children born in these areas" that have naturally fluoridated water that is 10-20 times higher than optimum. I have never seen an actual survey of birth defects in these high F areas.

 

Animal experiments do not indicate that fluoride is teratogenic at any dose. A recent FDA study in rats used doses up to 11.4 mg F/kg (25.1 mg as NaF, in drinking water) and found no developmental defects (see Collins).

 

Although not a birth defects study per se, the best example is in dairy cattle fed doses of fluoride that went from normal to fluorotic (see Newell). Essentially, all of the normal signs of fluorosis (teeth first, then hair and bone problems) appeared, but the signs of reproductive health (fertility, % of live births, and gestation time) all went slightly up and seemed to peak just before the highest dose.

 

It is noteworthy that these dairy cows, in their normal feeding pattern (whole grains and rough vegetable matter) and with low F well water (.1 to .2 ppm F), were getting a daily fluoride intake of .15 to .3 mg/kg. That works out to about 10 - 20 mg F per day for a 140 lb woman (but this should be divided by about 3 for bioavailability, making the "NaF" dose 3 - 6 mg F/day). The highest dose tested was 2.5 mg/kg, mostly NaF, or over 150 mg F for a 140 lb woman.

 

References:

Collins TF, Sprando RL, Shackelford ME, Black TN, Ames MJ, Welsh JJ, Balmaer MF, Olejnik N, Ruggles DI. Developmental toxicity of sodium fluoride in rats. Food Chem Toxic 1995; 33(11):951.

Mason JO (Committee to coordinate environmental health and related programs). Review of fluoride benefits and risks. US Public Health Service 1991. Teratologic and developmental effects are reviewed on pages 67-9.

Newell GW, Schmidt HJ. The effects of feeding fluorine, as sodium fluoride, to dairy cattle - a six-year study. Am J Vet Res 1958; 19: 363-76.

Teotia M, Teotia SPS, Singh RK. Metabolism of fluoride in pregnant women residing in endemic fluorosis areas. Fluoride 1979; 12(2):58.

Dosage table