Fluoride and heart disease – another myth

Here is another anti-fluoride rubber duck which keeps surfacing – the myth that cardiovascular disease is “linked to” fluoride. This myth relies on misrepresentation of a study reported in Nuclear Medicine Communications 2 years ago.

The paper is Li et al (2012) Association of vascular fluoride uptake with vascular calcification and coronary artery disease. (download pdf). It shows that an injected fluoride isotope (18F) concentrates in existing calcified material in coronary arteries. The authors suggest detection of the injected 18F could provide a clinical method of identifying cardiovascular risk.

This is very clear from the conclusion reproduced in their abstract:

“CONCLUSION: sodium [¹⁸F]fluoride PET/CT might be useful in the evaluation of the atherosclerotic process in major arteries, including coronary arteries. An increased fluoride uptake in coronary arteries may be associated with an increased cardiovascular risk.”

The “fluoride uptake” refers to uptake of the radioactive isotope in the coronary arteries, 40 minutes after its injection – not dietary uptake of fluoride. The correlation observed is between arterial calcification and 18F uptake – not dietary fluoride.

Yet anti-fluoride activists are referring to the paper to claim that heart disease is linked to dietary fluoride intake, especially from fluoridated water. For example, Declan Waugh claimed:

“Current research has also identified the link between fluoride and atherosclerosis.370

And yes his reference 370 is Li etal (2012) (see When politicians and bureaucrats decide the science).

The local anti-fluoride activist organisation Fluoride Action Network of New Zealand (FANNZ) today repeated this misinformation on their Facebook page (see Los Angeles Healthcare System Study Links Fluoride With #1 Cause Of Death – Cardiovascular Disease):

“The results of this study therefore have vast implications for our collectively becoming aware of one main contributing factor to the ongoing scourge heart disease, namely municipal water fluoridation. “

They also make similar claims on their webpage – see Fluoridation and Heart Disease):

“Research published in January 2012(1) concluded that there was a direct correlation between the fluoride level in arteries, including coronary arteries, and artherosclerosis . . . . . this unquestionably proves that fluoride does accumulate in soft tissue – something fluoridation promoters deny emphatically, claiming it all goes to the bones or teeth, and never the soft tissues.”

I repeat – the correlation reported is between atherosclerosis and the injected 18F. Nothing to do with dietary F intake at all. This correlation results from the fact the injected fluoride has an affinity with calcium and is therefore attracted to clacifying material . As the authors say:

“Currently, sodium [18F]fluoride positron emission tomography (PET)/CT is the most sensitive imaging modality to detect active bone formation”


“Calcification in atherosclerosis occurs through an active process that resembles bone formation”

Misrepresentation by motivated confirmation bias

So a clear misrepresentation of a scientific paper. Is this a mistake or is it intentional?

Clearly there is motivated confirmation bias going on. Understandably these activists will select anything to fit their case, even to the extent of making such whopping mistakes. Perhaps one can understand an individuial making such a mistake if they are simply glancing through titles, or abstracts, looking for “ammunition.”

But this is a mistake that keeps repeating. And it get’s included in their “authoritative” statements. For example Declan Waugh’s report is often used in submissions to councils and the Hamilton City Council admitted to being impressed by it. They describe it as one of the key pieces of information that lead them to their mistaken decision to stop fluoridation (see When politicians and bureaucrats decide the science). You can down load their own assessment of the information they considered important  –Scientific research supporting the stopping of fluoridation

On the one hand activist organisations like this should take more care with the material they prepare. When mistakes like this are pointed out they lose their credibility.

On the other had bodies like city councils should take more care in accepting information from submitters. They should be aware of the ever-present problem of confirmation bias which is inevitable with activist groups. They should not be impressed by something that looks “sciency” with large numbers of references.

Above all, they should always seek expert advice, rely on information from people who have the skills to undertstand the scientific literature and be aware of these sorts of mistakes.

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15 responses to “Fluoride and heart disease – another myth

  1. One can find proof that Mercola and other “leaders” embraced this truly amazingly mistaken understanding of the entire hypothesis of the nuclear medicine paper showing that fluoride tagged nucleotide imaging can predict coronary thrombosis.

    This error, in my experience, is the most egregious example of the blind affirmation of any thesis supporting fluoridation opposition so common in the public discussions. Sadly, often as not this sort of thing is politically effective.

    This example is most useful for communicating the arrogant ignorance of the anti-fluoridation movement to medical professionals who instantly understand the error.


  2. Do the anti-fluoridationists ever retract when these sort of things are exposed?

    (thinks hard)

    I suggest that the wording in post title be changed, from using “myth” to the more accurate description: “lie”.


  3. I’m interested in how the uptake of radioactive fluorine isn’t representative of dietary fluorine? I understand they are not the same, but are they not similar enough to make a correlation? And if not, why?


  4. As with other isotopic investigations the assumption is that the radioactive isotope behaves very similarly to the non-radioactive ones (although there may be minor rate effects).

    But in this case the radioactive F is not used as a tracer for dietary F. It is simply a diagnostic tool to detect areas of active calcification because of its attraction to those areas. Dietary F will also be attracted to those areas over a longer time but cannot be detected by scanning.

    The important things is that the F, radioactive or not, does not cause the calcification.


  5. Do you think this is the first claim that fluoride causes heart disease? Do you think it was a coincidence that research in the 1950’s and 1960’s showed the same thing?

    One in a million; The American Dental Association, [1962]
    “This film attempts to persuade people who are opposed to the fluoridation of drinking water that they are mistaken in thinking that fluoride, in minute quantities, is toxic, may cause cancer or heart or kidney disease, leads to bone fractures, or is unconstitutional.”

    And notice what they did to persuade people fluoride was safe:

    “To the man who claims that fluoride attacks the heart and kidneys and increases the risk of cancer, Dr. Paul Dudley White, a famous cardiologist, replies that there is no evidence to suggest that fluoride in any way affects or causes these diseases.”

    They said there is no evidence. They didn’t say there was evidence to confirm it was safe. They just nitpicked flaws in the research to claim it was not reliable, then they go back to having no evidence. It’s a childish game to remain willfully ignorant. Some things never change, eh?

    Sorry, but if fluoridation was such a good thing, you would be able to prove your claim in a controlled laboratory setting the way that Li et al did. They proved it was harmful. They officially have more evidence to their claim than you do. Where is your evidence to prove it is safe? You don’t have any, do you?


  6. Anna, you are completely confused. Li et al. did not prove fluoride harmful at all. They simply showed the use of a radioactive fluoride tracer and catscan enabled detection of calcified tissues. it was in a real life setting – not a laboratory setting.

    You are also confused about evidence for safety. This inevitably boils down to lack of evidence for any harm. Think about it. There has never been any experimental evidence to prove water is safe is normal consumption levels. Yet we call it safe becuase there is no evidence of harm. This does not mean that one day we might not find some harmful effect. That is the way knowledge works.

    It is exactly the same with fluoride.


  7. Ken, I think you are completely confused about the point I am making. When organizations are facing accusations of causing harm, if they cannot muster evidence to defend themselves, things aren’t going to turn out very well. You can ask Pfizer about that one:

    Manufacturers of the atypical anti-psychotic medications have been the targets of all of these kinds of lawsuits, resulting in some of the largest settlements ever seen in pharmaceutical litigation. Pfizer holds the dubious record, paying $2.3 billion in 2009 to settle an enforcement action involving Geodon as well as other drugs. Of this total, $1.3 billion was assessed as a criminal fine, an unusually severe penalty in a case of corporate misconduct.

    ADA’s New Zealand study, which didn’t bother to control for the use of fluoride supplements, or total intake, doesn’t hold a candle to the 180 studies presented by anti-fluoridation opponents in their EPA petition, some of which have successfully demonstrated children with fluorosis have significantly lower IQ. It’s a little hard to side-step that one.
    Source: https://www.ncbi.nlm.nih.gov/pubmed/21911949

    But why stop there? We can go into the exact mechanism if you want. You see, it depends on which “fluoride” you are talking about when you say it doesn’t have evidence that it causes harm. It just so happens that Fluoride ions in water have a high affinity for metals such as aluminum. Aluminum fluoride is a well-established neurotoxin.

    Fluorides are properly defined as binary compounds or salts of fluorine and another element. … In water, fluorides associate with various elements present in the water, mainly with aluminum in freshwater and calcium and magnesium in seawater

    Because of the great affinity between fluorine and aluminum, it is possible that the greatest impairments of structure and function come about through the actions of charged and uncharged AlF complexes (AlFx).

    You can find all kinds of studies that intricately explain how fluorides with aluminum, magnesium and beryllium act on g-proteins to alter CNS and endocrine function. Sources:

    Apparently, no one thought of that until recently.

    Nomination Date: 02/04/2000
    Nominator: NIEHS, EPA
    Status: Selected
    Aluminum is a listed by the EPA as a drinking water contaminant with a high health research priority. Since aluminum is found in nearly all drinking water and fluoridation may enhance absorption, there is a need for long-term low concentration rodent studies. The effects of aluminum citrate & aluminum fluoride complexes on body burdens of aluminum including the brain need to be evaluated.

    But of course, as long as the NTP doesn’t complete the above study (which was nominated in 2000), they won’t have evidence it causes harm. Like I said, it’s a childish game. Picking and choosing what people should or should not know out of personal convenience is not how knowledge should work.


  8. Anna, obviously no public health authority, medical or dental association or scientific body on the planet shares your concern.

    Have you a reason why?

    We can go into the exact mechanism if you want.

    Who is “we” ?


  9. Ann, you claim I am confused about the point you were making.
    Really? Well this is how I understood your point:

    You asserted fluoridation was harmful to the heart and disagreed with my article describing the Li et al study. You specifically claim of Li et al:

    “They proved it was harmful. They officially have more evidence to their claim than you do. “

    I pointed out your mistake. That the study had nothing to do with fluoride causing heart problems. It simply described a method for locating calcareous deposits using radioactive F as a tracer.

    I take it from your desire not to discuss this further that you know accept my point.
    None of the multiple links you provided have anything to do with fluoridation and harmful effect. Nothing.

    Your first link on antipsychotic drugs does not mention fluoride or fluoridation and heart disease. It is not relevant.

    You mention without providing any link or citation:

    “ADA’s New Zealand study, which didn’t bother to control for the use of fluoride supplements, or total intake, doesn’t hold a candle to the 180 studies presented by anti-fluoridation opponents in their EPA petition.”

    If you are referring to the Broadbent et al (2014) study then you are completely wrong. It did include fluoride supplements as a confounder and still showed that there is no statistically significant relationship of IQ with fluoridation.

    Similarly, studies in the last few years have also show this in Canada and Sweden.

    As for the arguments presented by the Connett crown in their petition. They were dealt with point by point and shown to be scientifically wrong I n the document rejecting the petition.

    I dealt with some of these in my draft paper CRITIQUE OF A RISK ANALYSIS AIMED AT ESTABLISHING A SAFE DAILY DOSE OF FLUORIDE FOR CHILDREN () and specifically with the ADHD claims of Malin and Till in the currently “in press” paper “Fluoridation and attention deficit hyperactivity disorder – a critique of Malin and Till”).

    Yes, there are some relatively poor studies showing health problems, including cognitive deficits, in areas of endemic fluorosis such as China, India and Mexico. Such studies are of course irrelevant to the fluoridation situation because of the high dietary intake of fluoride in such areas. No causation was shown in any of the studies you link. In contrast the IQ, data can be explained by non-chemical factors like effects of fluorosis ion self-esteem (Severe dental fluorosis and cognitive deficits) or premature birth (Valdez Jiménez et al 2017),

    You say “We can go into the exact mechanism if you want.” Yet do not explain any mechanism at all. Nothing.

    I am a chemist. Some of my early publications were on fluoride so I understand its chemistry. But the ability of Al to complex with F- is not a mechanism. In natural waters Al complexes with a range of other species. Silicate and organic compounds also. In treated water, there is extremely little Al because it, and associated compounds, are precipitated during flocculation.

    One of you last links to the paper by Mullenix is of interest because her study was very naïve. In fact, it was published only because she used a shonky journal where the author pays to get published. Heavy metal contaminants in water treatment chemicals are not a new discovery – that is why analysis certificates are required by regulating authorities.
    If you take the time to compare the amounts of heavy metal contaminants coming into your tap water from these chemicals with the actual amounts already present in the pure source water you will see that the contribution from treatment is minuscule – less than one hundredth of that already present in the source water. Read my article Chemophobic scaremongering: Much ado about absolutely nothing.


  10. recreational athlete

    Fluoride is an endothelial toxin.
    I found bunches of articles describing how difficult it is to reverse fluoride poisoning. The dose makes the poison, but in municipal water there is no controlling the dose. Some people drink bunches of tap water, some none at all. Kids are notorious for not wanting to drink water, but they are the major target for fluoride. It seems that Vitamin C, D and calcium are protective of fluoride poisoning, but why should you need an antidote for your own water supply?


  11. Recreational athlete – could you please cite scientific studies to support your claim “Fluoride is an endothelial toxin” and explain how they are relevant to community water fluoridation?

    I am never swayed by statements like “I found bunches of articles describing how difficult it is to reverse fluoride poisoning.” They usually simply indicate a bias and the lack of citation displays an unwillingness to put the claims to a test.

    In short – “Put up or . . . “


  12. Hi Ken, I don’t think you’re convincing anyone with this combo of nitpicking and histrionics, and wriggling around about what one paper said in 2012, which lest we forget was “An increased fluoride uptake in coronary arteries may be associated with an increased cardiovascular risk.”. https://www.ncbi.nlm.nih.gov/pubmed/21946616

    The topic of sodium [¹⁸F]fluoride PET/CT and other imaging techniques for atherosclerosis has since moved on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064897/

    The affinity of a lot of one isotope fluoride in the short term has implications for the affinity of a little of other isotopes over a longer time.

    Even pro-densifiers of the human frame such as the fluoridationists (I can’t really think of any other modern examples) agree fluoride is cumulative. As in so many areas, you may do what salesmen are supposed to do, which is to make salient what is advantageous to you and your customer, and ignoring or rubbishing anything which isn’t.

    Cumulativity is one of those. In fact just about anything discovered about fluoride by non-fluoridationist science lies outside the rather narrow range of topic areas you like, and goes against the salesman’s favourite acronym KISS…keep it simple stupid.

    So it doesn’t matter how much or what isotope. What matters is how little. What matters is whether or not. Fluoride which isn’t there can’t do anything, and normal people with normal doubts would doubtless settle for that.

    But not you. So why, if specialists in sodium [¹⁸F]fluoride PET/CT imaging for atherosclerosis agree with your pronouncement that their findings are irrelevant to dietary fluoride and variations in its uptake, would they say otherwise? It is now considered useful as a predictor of future cardiovascular timelines: 18F‐fluoride uptake correlated strongly with the subsequent rate of progression in aortic valve calcium score and independently predicts cardiovascular death and aortic valve replacement after age and sex adjustments (hazard ratio: 1.55; 95% CI, 1.33–1.81; P<0.001)

    My deeply scientific opinion is that more fluoride means more fluoride reactions and less can only mean less of them. It really is as simple as that. Only a buffoon would consider his time well spent trying to claim otherwise,


  13. you are attempting to retrieve an impossible situation. The paper I cited (and you repeated the citation) does say in the conclusions “An increased fluoride uptake in coronary arteries may be associated with an increased cardiovascular risk.” But it is very clear this was referring to the uptake of 18F use to obtain the images. It is simply not a statement on dietary F intake.

    The second paper you cite says exactly the same thing.

    My understanding is that this imaging technique is now being offered as a way of detecting arterial calcification in practice.

    Your last paragraph is simply saying nothing

    “My deeply scientific opinion is that more fluoride means more fluoride reactions and less can only mean less of them. It really is as simple as that. Only a buffoon would consider his time well spent trying to claim otherwise,”:

    It certainly is not “deeply scientific” to state something that is so obvious. And it certainly is not relevant to my post.


  14. In #fluorothink, science and obviousness received their degree absolute.

    But I’m sure water runs downhill whether there is a little or a lot, and that this was obvious before science gave it a name.

    You don’t really know how much fluoride anyone has had today, Yet you think you can “optimise” everybody’s at once. https://twitter.com/turizemptuj/status/1153476426714079232

    Then there’s Hartlepool being 4.2% richer.

    All seems pretty obvious to me. As does the statement Matt Hancock cannot bring himself to disagree with, that there can be no harm from added fluoride if fluoride is not added.

    So don’t. But I expect you’ll want to go through and correct me on all of these obvious things, even though your last answer was a little racinated.


  15. turizemptuj – I have no idea of what you are talking about. What relevance do you comments have to the article which was about they way anti-fluoride campaigners are naively misrepresenting the research described by Li et al (2012) Association of vascular fluoride uptake with vascular calcification and coronary artery disease?


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