AHS Question #1 - September 27, 2021

[admin]

September 27, 2021

The question below was posted today on the website of the Alberta Health Services (AHS). The website invites questions about fluoridation, so that people may separate "fact from fiction". Calgary will vote on fluoridation on Oct. 18, 2021.

• SEE: AHS website - Fact or Fiction
  https://together4health.albertahealthse ... tool=qanda

We asked this question because the AHS stated that "it is safe to drink fluoridated water during pregnancy."

A response from Alberta Health Services was received on October 7, 2021. Unfortunately, the AHS did not address our concerns about TSH levels during pregnancy. We have posted the AHS response below the letter, as well as our reply to it. Please follow the thread.

• PFPC letter - Sept. 27, 2021. viewtopic.php?f=91&t=3693
  AHS Response - Oct. 7, 2021. viewtopic.php?p=4418#p4418
  PFPC Response to AHS - Oct. 8, 2021. viewtopic.php?p=4419#p4419

UPDATE Oct. 24, 2021: The AHS did not reply again, but used the same wrong information in response to another concerned resident's inquiry about fluoride effects on the thyroid. AHS closed the discussion after the election on Oct. 18, 2021. Emails sent to the AHS remain unanswered.

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Question:

You state that it is safe to drink fluoridated water in pregnancy, referring to the recent IQ studies.

What about fluoride effects on TSH, the thyroid-stimulating-hormone?

Fluoride raises TSH levels even at water concentrations used for community water fluoridation (1). The actual evidence reviewed in the 2019 CADTH report shows this quite clearly (2).

Out of the 5 CADTH-reviewed papers that reported TSH values, 3 reported an increase of TSH levels with increasing fluoride intake (see Kheradpisheh et al., 2018; Xiang et al., 2009; Singh et al., 2014). A fourth (Khandare, 2017) was done at high altitude where TSH/TH metabolism is vastly different, and the 5th by Alberta's McLaren and Barberio used an outdated reference range upper limit of 4.8 mIU/L, almost twice as high as the 2.5 mIU/L upper limit for the first trimester. It is incomprehensible how that study on thyroid and IQ failed to consider TSH limits during pregnancy (3).

WHY IS THIS IMPORTANT?

The cut-off upper limit for TSH in the first trimester is 2.5 mU/L, as advised by most international health organizations, including the Alberta Medical Association (4). This limit is set because TSH levels above 2.5 mU/L are associated with a decrease in cognitive function in offspring (5,6), as well as adverse pregnancy outcomes such as miscarriage, pre-term birth, and low birth weight (6). There are now hundreds of studies documenting adverse health outcomes correlating with increasing TSH levels above 2.5 mIU/L - but still within the normal range, including cardiovascular disease, metabolic syndrome (MetS), Non-Alcoholic Fatty-Liver-Disease (NAFLD), thyroid cancer, and diabetes (7).

The weight of the available scientific evidence appears to show that not only is fluoridated water unsafe for pregnant women but steps should be undertaken to reduce all high sources of fluoride during pregnancy, such as tea, grape products, oral care products, etc...

Why is the TSH issue not addressed?

Thank you for your answer.

Wendy Small
PFPC Canada


1) Kheradpisheh Z, Mirzaei M, Mahvi AH, Mokhtari M, Azizi R, Fallahzadeh H, Ehrampoush MH - "Impact of Drinking Water Fluoride on Human Thyroid Hormones: A Case-Control Study" Scientific Reports Volume 8:2674 (2018)
https://www.nature.com/articles/s41598-018-20696-4
At fluoride water concentrations from 0.3 to 0.5 ppm, TSH was increased by 0.5 mIU/L, compared to the area with 0 to 0.3 ppm. In this study, fluoride resulted in a TSH increase from 2.2 mIU/L to 2.7 mIU/L. (2.7 mIU/L is above the recommended upper limit of TSH for the first trimester of pregnancy.)
"It was found that fluoride has impacts on TSH, T3 hormones even in the standard concentration of less than 0.5 mg/L."

2) CADTH TECHNOLOGY REVIEW Community Water Fluoridation Programs: A Health Technology Assessment — Review of Dental Caries and Other Health Outcomes (2019)
https://www.cadth.ca/sites/default/file ... report.pdf

3) PFPC - Comments on the study by Barberio et al. (2020)
viewtopic.php?f=7&t=2376

4) TOP Alberta - Clinical Practice Gudielines - Thyroid (2014)
https://actt.albertadoctors.org/CPGs/Li ... deline.pdf

5) Wang M, Liu L, Li H, Li Y, Liu H, Hou C, Zeng Q, Li P, Zhao Q, Dong L, Zhou G, Yu X, Liu L, Guan Q, Zhang S, Wang A - "Thyroid function, intelligence, and low-moderate fluoride exposure among Chinese school-age children" Environ Int 134:105229 (2020)
https://pubmed.ncbi.nlm.nih.gov/31698198/
"We detected a significant modification effect by TSH on the association between urinary fluoride and IQ scores, without mediation by THs."

6) Lee SY, Pearce EN - "Testing, Monitoring, and Treatment of Thyroid Dysfunction in Pregnancy" J Clin Endocrinol Metab 106(3):883-892 (2021)
https://academic.oup.com/jcem/article-a ... m=fulltext

7) PFPC - 70 studies on adverse effects: TSH within the normal range (2021)
viewtopic.php?f=7&t=2300

[admin]

Alberta Health Services October 8, 2021

Our response has now been posted on the site.

Our response:

Thank you for your question.

We acknowledge the existence of all scientific evidence available related to community water fluoridation; however from a public health perspective, decisions made on recommendations are based on the most up-to-date scientific evidence, all of which include research on thyroid and IQ.

To answer your question, the thyroid is a hormone-producing gland found in the neck and is responsible for controlling metabolism in the body. Low thyroid hormone, known as hypothyroidism, contributes to symptoms of tiredness, weight gain, a sense of feeling cold. Thyroid hormone is also responsible for regulating metabolism.

Thyroid activity is measured indirectly through a simple blood test (TSH, T3 and T4). The Canadian Agency for Drugs and Technologies in Health (CADTH) reviewed 8 studies looking at fluoride exposure and thyroid function. In general, these studies found no significant difference in thyroid size nor function according to current recommended fluoride exposure levels in Canada (once confounders are accounted for). Under Health Canada guidelines, the recommend [sic] level of fluoride for community water fluoridation is 0.7mg/L (0.7ppm) which falls well below the maximum acceptable concentration (MAC) of 1.5mg/L (1.5 ppm). The O’Brien Institute for Public Health report of the CADTH literature review and Canadian studies looking at fluoride exposure in this range, observed no clinically significant thyroid-related health effects.

Higher fluoride exposure (above the Canadian recommendation for optimal community water fluoridation) may be associated with a minor increase in TSH levels, but this increased level is still within the normal range. This increase only occurs in individuals with iodine-deficiency, which is relatively uncommon in Alberta.

Scientific research towards more specific topics continues to evolve, however the best scientific evidence available supports community water fluoridation as a safe and effective measure to prevent tooth decay.

Please let us know if you have any more questions or if anything needs to be clarified.

Regards

Alberta Health Services

[admin]

Wendy Small, PFPC Canada October 8, 2021

Thank you for your response.

However, you did not really answer my question.

My inquiry was related to TSH levels during pregnancy - specifically - and was in response to your statement proclaiming the safety of fluoride during pregnancy.

As I am sure you know, "normal" reference ranges for TSH do not apply during pregnancy.

I provided you with evidence from the studies reviewed by the CADTH that even fluoride concentrations BELOW those contemplated for fluoridation in Calgary increased TSH to levels above the threshold of 2.5 mIU/L for the first trimester, an upper limit advocated by the AMA in concert with treatment guidelines used by health organizations worldwide (1).

In particular, I referred to the 2018 study by Kheradpisheh et al. showing that an elevation of fluoride water levels from 0.3 to 0.5 ppm caused TSH levels to increase from 2.2 mIU/L to 2.8 mIU/L (2).

[See Table 2: https://www.nature.com/articles/s41598- ... 4/tables/2 ]




Neither the O'Brien Institute nor the CADTH considered TSH levels during pregnancy in their reports (3,4).

It is further incorrect to state that a "minor increase in TSH levels" ONLY occurs in iodine-deficient individuals or at intake levels "higher" than those in "optimal" CWF areas. While fluoride effects on TSH are much more pronounced in iodine deficiency or hypothyroidism (2,5), to state that they only occur in individuals with iodine deficiency is false.

In the study by Kheradipisheh, no one in the control group - where the above-described elevation of TSH by fluoride was observed - was iodine-deficient nor had any thyroid dysfunction.

How can the Alberta Medical Association or Alberta Health Services promote water fluoridation knowing that it might raise TSH to dangerous levels during the first trimester, hence putting the fetus and mother at risk of serious adverse health events?

There are over international 250 studies published in the last 20 years alone, documenting the effects of fluoride on thyroid hormone metabolism not only in children and adults, but also in various animals and established toxicological models - many at intake levels directly comparable to those in fluoridated areas (6).

This is not isolated evidence.

Could you please indicate how the AHS will deal with this issue?

Will you warn the public that consuming fluoridated water during the first trimester may raise TSH to dangerous levels, putting the fetus and mother at possible risk for serious adverse health events?

We would appreciate it greatly if you could post this response with links on your website "Truth or Fiction", so that the public may be correctly informed on this important aspect.

We look forward to your reply.

Thank you.

Wendy Small
PFPC Canada


REFERENCES:

(1) TOP Alberta - Clinical Practice Guidelines - Thyroid (2014)
https://actt.albertadoctors.org/CPGs/Li ... deline.pdf

(2) Kheradpisheh Z, Mirzaei M, Mahvi AH, Mokhtari M, Azizi R, Fallahzadeh H, Ehrampoush MH - "Impact of Drinking Water Fluoride on Human Thyroid Hormones: A Case-Control Study" Scientific Reports Volume 8:2674 (2018)
https://www.nature.com/articles/s41598-018-20696-4

(3) O’Brien Institute for Public Health - University of Calgary - Community Water Fluoridation - A Report for Calgary City Council (2019)
https://tinyurl.com/yu2jex4n

(4) CADTH TECHNOLOGY REVIEW Community Water Fluoridation Programs: A Health Technology Assessment — Review of Dental Caries and Other Health Outcomes (2019)
https://www.cadth.ca/sites/default/file ... report.pdf

(5) Lin Fa-Fu, Aihaiti, Zhao Hong-Xin, Lin Jin, Jiang Ji-Yong, Maimaiti, Aiken - "High-fluoride and Low-iodine Environment and Subclinical Cretinism in Xinjiang" Endem Dis Bul 6(2):62-67 (1991)
https://poisonfluoride.com/dir/wp-conte ... F-1991.pdf
English Translation in: ICCIDD Newsletter, Volume 7 Number 3 (August 1991)
https://poisonfluoride.com/pfpc/lin-1991.pdf

(6) PFPC - Recent Research: 2001 - 2021 (250+ studies)
viewtopic.php?f=7&t=1345