Tuesday, August 14, 2012

Risk Factors and Cancer Incidence in Ireland and Implications for Water Fluoridation and Public Health.

To:       Dr. Harry Comber, National Cancer Registry Ireland

Cc:       Mr. Enda Kenny T.D. Department of the Taoiseagh

Dr. James O Reilly T.D. Minister for Health

Mr. Simon Coveney T.D.  Minister For Agriculture, Food and Fisheries

Mr. Phil Hogan T.D. Minister for Environment, Community and Local Government

Dr. Tony Holohan, Chief Medical Officer, HSE
Dr. Ivan Perry, Professor of Public Health Department of Epidemiology & Public Health, University College Cork

Ms. Laura Burke, Director General, Environmental Protection Agency

Risk Factors and Cancer Incidence in Ireland and Implications for Water Fluoridation and Public Health.

Dear Sirs

I am writing to you regarding the information provided in the National Cancer Registry Ireland (NCRI) cancer statistic maps. As you know these maps illustrate the geographical spread of cancer diseases and identify areas of high and low risk for the 32 countries of Ireland.

What is one of the most obvious and interesting facts in these illustrations is that Northern Ireland is identified as predominantly the lowest risk area for developing cancer diseases throughout the 32 counties of Ireland. In fact it is astonishing to see that the relative risk of developing cancer actually mirrors the geographic area demarcating the border between the Republic of Ireland and Northern Ireland for some notable cancers  (see fig 1. attached).

From the position of identifying potential risk factors that may contribute to this notable phenonomen, it is noteworthy that the influence of hexafluorosilicic acid and its various compounds in drinking water was not included as a factor in contributing to cancer disease. This is particularly the case as the only known difference in population exposures to known environmental toxins between Northern Ireland (NI) and the Republic of Ireland (ROI) is that the drinking water supply is not fluoridated in NI while it is fluoridated with hexafluorosilicic acid in the ROI.

Of interest to your researchers and data analysts should also be the influence of drinking water chemistry on disease prevalence, in particular how low calcium and magnesium  drinking waters increase the risk of developing cancer as well as other diseases such as cardiovascular and neurological illness. The WHO have published a report[1] highlighting the fact that the concentration of calcium and magnesium in drinking water plays a very significant role in the development of cancer and illhealth amongst the population as a whole.

The importance of these facts was examined in some detail in an independent scientific report[2] published in March of this year, which highlighted large geographic areas of the country and their respective populations who consume fluoridated low calcium and magnesium waters, present in many parts of Ireland, where the calcium levels can be <20mg/L in comparison to other geographic areas of the country where the calcium level in drinking water may be in excess of 300mg/l.

The bioavailability of calcium and magnesium was addressed by the WHO in their report[3] when they stated that:

 "The bioavailability of calcium from water is likely to be influenced by the same factors that affect calcium bioavailability from food, which has been reviewed. The presence of anions in certain waters can influence the bioavailability of calcium from either water or other sources in the diet."

Current scientific knowledge clearly accepts that Fluoride influences the bioavailability of calcium in drinking water. It is now known that the lower the calcium content in water the higher the blood plasma fluoride content in consumers who drink fluoridated water.  Furthermore the prestigious U.S. National Research Council (NRC), in their published report[4] on fluoride, stated that:

Fluoride clearly has the effect of decreasing serum calcium and increasing the calcium requirement in some or many exposed persons.”

Fluoride’s interaction with calcium was also noted by Masters et al[5] when they
reported that:

“apart from the possibility of direct toxicity the dissociated fluoride ions is known to bind calcium. If diets are low in calcium the products of silicofluoride dissociation can exacerbate the competition between calcium and lead for bone and soft tissue sites.”

It is widely known that dietary calcium severely restricts fluoride assimilation from the GI tract into the bloodstream.[6],[7] In other words diets high in calcium lower blood plasma fluoride levels from drinking fluoride water. In the same manner it is now known that diets low in calcium enhance the effects of fluoride on total plasma calcium.[8],[9],[10],[11] It has been reported by Teotia et al.[12] that fluoride appears to exaggerate the metabolic effects of calcium deficiency on bone and Tiwari et al.[13] provides a description of a mechanism by which fluoride exposure in the presence of calcium deficiency further increases the dietary requirement for calcium, namely by altering the expression of genes necessary for calcium absorption from the gastrointestinal tract. It is now well established that the indirect action of fluoride induces a net increase in bone formation[14] and also decreases calcium absorption from the gastrointestinal tract,[15],[16],[17] both of these effects lead to an increase in the body’s calcium requirement.[18],[19] If dietary calcium is inadequate to support the increased requirement, the response is an increase in secondary hyperparathyroidism.[20] This view was supported by Krishnamachari in his review[21] when he found that in the presence of inadequate calcium, fluoride directly or indirectly stimulates the parathyroid glands, causing secondary hyperparathyroidism leading to bone loss. It is also now known that secondary hyperparathyroidism in response to calcium deficiency may contribute to a number of diseases, including osteoporosis, hypertension, arteriosclerosis, degenerative neurological diseases, diabetes mellitus, some forms of muscular dystrophy, and colorectal carcinoma.[22]

It is further known that calcium deficiency induced or exacerbated by fluoride exposure may contribute to other adverse health effects.[23] For example, Goyer[24] indicates that low dietary calcium increases the concentration of lead in critical organs and the consequent toxicity.

As noted in the report entitled Human Toxicity, Environmental Impact and Legal
Implications of Water Fluoridation the interaction of fluoride and calcium was a matter of some concern to the British Medical Research Council[25] who stated that:

“the question of the bioavailability of ingested fluoride is important, especially with respect to the possible influence of water hardness on uptake and differences between naturally fluoridated and artificially fluoridated water.”

The British Medical Research Council (BMRC) also observed that:

“a major area of uncertainty concerns the bioavailability of fluoride. This is particularly important with respect to the possible differential absorption of fluoride from naturally and artificially fluoridated water and the role of water hardness (calcium levels).”[26]

The BMRC has further stated in this regard that:

“If the bioavailability of ingested fluoride can vary significantly, this might need to be taken into account in the interpretation of epidemiological studies.”

As noted in the Waugh report[27] no such studies have ever taken place in Ireland and unfortunately neither water fluoridation nor water chemistry were included in any of the risk characteristics examined by the NCRI for the published cancer incidence maps of Ireland. 

It is evident that these risk characteristics should have been included given the published findings in a peer-reviewed cancer research journal[28] in 2006 which reported a five-fold increased risk of developing osteosarcoma among teenage boys exposed to fluoridated water at ages 6, 7, and 8 as reported by Dr. Elise Bassin and a team of Harvard University scientists. From available epidemiological data it is also a known fact that there is a significant increased risk of developing this disease in the ROI compared to NI. It is also known that the U.S. National Toxicology Program[29] found 'equivocal evidence' in animal experiments that fluoride was carcinogenic in 1990.

This would further support the inclusion of fluoride as a possible contributory factor to an increased risk of cancers as noted in your maps. Indeed the trade union representing some 7,000 scientists, toxicologists and professionals in the U.S. Environmental Protection Agency believe that this former classification is incorrect and that fluoride should be classified as a known carcinogen.

Also of note is the research by Dr. Yiamouyiannis which documented that fluoride can increase tumour growth rate by 25% at only 1 ppm, can produce melanotic tumours, can transform normal cells into cancer cells and can increase the carcinogenesis of other chemicals.[30]

In addition, epidemiological studies undertaken by Dr. Dean Burk, former head of the Cytochemistry Section at the U.S. National Cancer Institute and Dr. Yiamouyiannis determined that fluoridation increased the incidence of cancer deaths.[31]  Other research resurfaced by Dr. Dean Burk, documented studies examining cancer prevalence between the 10 largest U.S. cities with fluoridation and the 10 largest without. What researchers found was that following fluoridation, deaths from cancer went up immediately- in as little as a year.[32] As a result of which, the United States Congress ordered animal studies[33] to determine whether fluoride causes cancer under laboratory conditions.

The U.S. Public Health Service conducted these tests as the National Toxicology Program, with oral, liver, and bone cancer receiving special attention. The results were released in 1990 and revealed that fluoride could be a carcinogen. The results were released in 1990 and revealed that fluoride is a carcinogen. Not only did precancerous changes occur in the animals’ oral squamous cells as a result of increasing levels of fluoride in their drinking water, but there was an increase of tumors and cancers in these cells, a rare form of bone cancer (osteosarcoma) occurred only in animals given fluoride in their drinking water, there was an increase in the incidence of thyroid follicular cell tumors, and a rare form of liver cancer (hepatocholangiocarcinoma) occurred in animals given fluoride in their drinking water.

Furthermore  it was reported by Takahashi et al.[34] in the Journal of Epidemiology that researchers found 23 of 36 cancer sites (63.9%) were associated positively with fluoridation status, using World Health Organization data and the U.S. Fluoridation Census. The authors concluded that:

 “The likelihood of fluoride acting as a genetic cause of cancer requires consideration.”

This view appears to be supported by the prestigious U.S. National Research Council (NRC) in their report on fluoride in water and fluoride toxicity, when they stated that:

 “Fluoride appears to have the potential to initiate or promote cancers, particularly of the bone…,”[35]

The NRC further recommended further research be conducted on the effects of fluoride on the risk of bladder cancer, as well as thyroid, liver, kidney, pancreas, pineal and brain function in addition to fluoride’s possible association with nutritional deficiency with particular emphasis on fluoride’s impact on calcium metabolism. In total the  NRC listed over 50 additional epidemiology, toxicology, clinical medicine and environmental exposure assessments required to be undertaken on fluoride. Not one of these studies has ever been undertaken in Ireland or elsewhere since the publication of the report over six years ago. A full list of such studies is included in the Waugh  report.[36]

Notwithstanding the above what is also clearly evident from the NRCI cancer incidence maps is that the highest risk cancer geographic areas for all cancers include the lowest calcium drinking water areas that are artificially fluoridated; an act that dramatically increases the bioavailability and toxicity of fluoride compounds for consumers in these areas. This is extremely important given that silicofluorides and fluoride compounds are toxic substances.

Fluoride has been shown to be toxic, not only to the skeletal tissues, but also to the non-skeletal tissues such as the brain, liver, pancreas, endocrines and kidney.[37],[38] Recent peer-reviewed research now clearly establishes fluoride as a neurotoxin that can have a serious adverse impact on the developing brain.[39],[40],[41] In addition the WHO has advised in respect of fluoride toxicity that:

“Patients with kidney dysfunction may be particularly susceptible to fluoride toxicity.” [42]

There is now a growing body of scientific evidence that demonstrates that silicofluorides and their derivative compounds in drinking water may be regarded as insidious poisons that accumulate in the human body and environment over time. As with any poison the severity of the health problems depends on how much fluoride an individual is exposed to and at what stage in their development. In many respects, the toxicity of fluoride is similar to both lead and arsenic.  In fact the publication Clinical Toxicology of Commercial Products ranks fluoride above lead in terms of toxicity. As with both of these harmful substances, young children are most susceptible to their negative impact, which is one of the principle reasons that lead was banned as an additive to petrol and paint substances. Since 2006, lead and its inorganic compounds have been classified by the German Research Foundation as being "carcinogenic in animal experiments" similar to the findings for fluoride by the U.S. National Toxicology Program.

The toxicity of fluoride is associated with its high chemical and biological activity. Fluoride is known for its aggressive interactivity properties and actively seeks out essential elements like calcium and magnesium and interferes with their capacity to fulfil important metabolic processes in the body. Fluoride induced apoptosis (cell injury death) was demonstrated in the cells from different organs and tissues including lungs, kidneys, liver, brain, pancreas thymus, endometrium, bone marrow, hair follicles, erythrocytes and leukemic cells. It has been found that fluoride is a toxic anion that stimulates cellular oxygen consumption producing highly destructive free radicals such as superoxide radicals that can damage cell membranes and lead to oxidative stress. Oxidative stress is also a common mechanism by which chemical toxicity can occur in the liver. Fluoride depletes the energy reserves and the ability of white blood cells to properly destroy foreign agents by the process of phagocytosis.

Fluoride inhibits AdoHydrae and homocysteine metabolism which is linked to cardiovascular disease, atherosclerotic disease, congenital heart defects, Down Syndrome, neurodegenerative disorders including depression, schizophrenia, bi-polar disorder, epilepsy, behavioural disorders, Alzheimers disease and carcinogenesis.

Peer-reviewed scientific research has found an inverse association between fluoride in drinking water and decreased intelligence in children. Harvard School of Public Health last month published a scientific study in which it concluded that fluoride in drinking water was a developmental neurotoxin.[43]

In the study researchers stated amongst other observations the following:

 "A recent cross-sectional study based on individual-level measure of exposures suggested that low levels of water fluoride (range 0.24 to 2.84 mg/L) had significant negative associations with child’s intelligence (Ding et al. 2011)." AND "Fluoride readily crosses the placenta (ATSDR 2003). Fluoride exposure to the developing brain, which is much more susceptible to injury caused by toxicants than is the mature brain, may possibly lead to damage of a permanent nature (US EPA 2011).""

Professor Grandjean ( Professor of Environmental Health - Department of Environmental Health - Harvard School of Public Health) one of the principle researchers of the study and one of the world’s leading environmental and public health professionals noted the following regarding their findings:

"Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain, the effect of each toxicant may seem small, but the combined damage on a population scale can be serious”.

Fluoride has also been found to depress melatonin synthesis in the pineal gland and induce accelerated sexual maturity in both humans and animals. It is also accepted that fluoride has profound effects on the skeleton. It has been found to cause decreased cortical bone mineral density, poor bone quality, increased skeletal fragility, osteomalacia, rickets, periodontal disease, osteoporosis, osteoporotic hip fractures and is positively associated with rhematopid arthritis, bone pain and proximal myopathy (neuromuscular disease resulting in muscle weakness).

These observations are supported by the Journal of American Physicians and Surgeons[44] in their review of water fluoridation in which they concluded:

"There is evidence that fluoridation increases the incidence of cancer, hip fractures, joint problems, and that by causing fluorosis it damages both teeth and bones. Other medical problems may also occur, including neurological damage."

In conclusion, it is evident from the NRCI maps that the highest risk areas for cancer disease are those where the population consumes artificially fluoridated water, especially soft water areas of Ireland with low calcium and magnesium levels.

Within the ROI areas that were identified as low risk, included are geographic locations where there is an increased dependence on drinking water abstracted from private wells or community water schemes that are non-fluoridated or locations where more alkaline waters with higher calcium and magnesium concentrations are present, thereby reducing the exposure, bioavailability and toxicity of fluoride for humans.

For disease such as blood cancers the incidence and risk of cancer is so uniform in NRCI maps that the influence of fluoride cannot be discounted as a major contributory factor to this disease burden on the Irish population. Similarly with pancreatic cancer, the influence of fluoridated foods and blood plasma fluoride levels cannot be discounted as a contributory factor for the development of this disease, especially as fluoride is scientifically documented to be an enzymatic poison and metabolic inhibitor.

I would ask therefore that you strongly recommend, in light of recently published scientific findings demonstrating the human health impacts of fluoride and in particular the remarkable correlation of the NCRI cancer incidence maps with exposure of the population to fluoridated water, noting how the maps clearly identify that citizens of Northern Ireland (being also the only geographic region of this island where the population is not exposed to fluoride in drinking water) have a lower risk of developing cancer diseases and that the evidence is convergent in demonstrating that fluoride may play a significant role in the development of such diseases.

In such circumstances it is clearly incumbent on the Irish Government to uphold its moral and legal obligation, to comply with the ‘precautionary principle’ and to call for an immediate cessation of this policy in line with other European nation states many of whom ceased fluoridation of water supplies on human health risk grounds.

In doing so the population of the entire island of Ireland will be provided with non-fluoridated drinking water, a basic legal right provided to the remaining 98% of the population of Europe.

Yours sincerely

Declan Waugh

[1] World health Organisation (WHO) document titled Calcium and magnesium in Drinking Water; Public Health Significance 2009.
[2] Waugh D. Human Toxicity, Environmental Impact and Legal Implications of Water Fluoridation, Submitted to Government of Ireland, March 2012.
[3] World health Organisation (WHO) document titled Calcium and magnesium in Drinking Water; Public HEALTH significance 2009.
[4] USA National Research Council, Fluoride in Drinking Water: A Scientific Review of EPA‘s Standards, Committee on Fluoride in Drinking Water, (2006), Page 251
[5] R.D.Masters, M,J,Coplan, B.T.Hone, J.E. Dykes, Association of silicofluoride treated water with elevated blood lead. Neurotoxicology 21(6) 1091-1100, 2000.
[6] USA National Research Council, Fluoride in Drinking Water: A Scientific Review of EPA‘s Standards, Committee on Fluoride in Drinking Water, (2006)
[7] Whitford. G.M, Effects of plasma fluoride and dietary calcium concentrations.
Calcified Tissue International, Volume 54, Number 5 (1994), 421-425,
[8] M. Joost Larsen, A. Richards and O. Fejerskov, Calcified Tissue International Volume 33, Number 1 (1981), 541-544, DOI: 10.1007/BF02409486
[9] Teotia, M., S.P. Teotia, and K.P. Singh. 1998. Endemic chronic fluoride toxicity and dietary calcium deficiency interaction syndromes of metabolic bone disease and deformities in India: Year 2000. Indian J. Pediatr. 65(3):371-381.
[10] Gupta, S.K., T.I. Khan, R.C. Gupta, A.B. Gupta, K.C. Gupta, P. Jain, and A. Gupta. 2001. Compensatory hyperparathyroidism following high fluoride ingestion—a clinico- Biochemical correlation. Indian Pediatr. 38(2):139-146.
[11] Krishnamachari, K.A. 1986. Skeletal fluorosis in humans: A review of recent progress in the understanding of the disease. Prog. Food Nutr. Sci. 10(3-4):279-314.
[12] Rosenquist, J.B., P.R. Lorentzon, and L.L. Boquist. 1983. Effect of fluoride on
parathyroid activity of normal and calcium-deficient rats. Calcif. Tissue Int. 35(4-
[13] Tiwari, S., S.K. Gupta, K. Kumar, R. Trivedi, and M.M. Godbole. 2004. Simultaneous exposure of excess fluoride and calcium deficiency alters VDR, CaR, and Calbindin D
9 k mRNA levels in rat duodenal mucosa. Calcif. Tissue Int. 75(4):313-320.
[14] Chavassieux, P., P. Pastoureau, G. Boivin, M.C. Chapuy, P.D. Delmas, and P.J.
Meunier. 1991. Dose effects on ewe bone remodeling of short-term sodium fluoride administration—a histomorphometric and biochemical study. Bone 12(6):421-427.
[15] Krishnamachari, K.A. 1986. Skeletal fluorosis in humans: A review of recent progress in the understanding of the disease. Prog. Food Nutr. Sci. 10(3-4):279-314.
[16] Stamp, T.C., M.V. Jenkins, N. Loveridge, P.W. Saphier, M. Katakity, and S.E. MacArthur. 1988. Fluoride therapy in osteoporosis: Acute effects on parathyroid and mineral homoeostasis. Clin. Sci. 75(2):143-146.
[17] Ekambaram, P., and V. Paul. 2001. Calcium preventing locomotor behavioral and dental toxicities of fluoride by decreasing serum fluoride level in rats. Environ. Toxicol. Pharmacol. 9(4):141-146
[18] Pettifor, J.M., C.M. Schnitzler, F.P. Ross, and G.P. Moodley. 1989. Endemic skeletal fluorosis in children: Hypocalcemia and the presence of renal resistance to parathyroid hormone. Bone Miner. 7(3):275-288.
[19] Ekambaram, P., and V. Paul. 2001. Calcium preventing locomotor behavioral and dental toxicities of fluoride by decreasing serum fluoride level in rats. Environ. Toxicol. Pharmacol. 9(4):141-146
[20] USA National Research Council, Fluoride in Drinking Water: A Scientific Review of EPA‘s Standards, Committee on Fluoride in Drinking Water, (2006), Page 250
[21] Krishnamachari, K.A. 1986. Skeletal fluorosis in humans: A review of recent progress in the understanding of the disease. Prog. Food Nutr. Sci. 10(3-4):279-314.
[22] Fujita, T., and G.M. Palmieri. 2000. Calcium paradox disease: Calcium deficiency prompting secondary hyperparathyroidism and cellular calcium overload. J. Bone Miner. Metab. 18(3):109-125.
[23] USA National Research Council, Fluoride in Drinking Water: A Scientific Review of EPA‘s Standards, Committee on Fluoride in Drinking Water, (2006), Page 251
[24] Goyer, R.A. 1995. Nutrition and metal toxicity. Am. J. Clin. Nutr. 61(3 Suppl.):646S
[25] UK Medical Research Council Working Group Report: Water Fluoridation and
Health, September 2002, Page 11.
[26] UK Medical Research Council Working Group Report: Water Fluoridation and
Health, September 2002, Page 15.
[27] Waugh D. Human Toxicity, Environmental Impact and Legal Implications of Water Fluoridation, Submitted to Government of Ireland, March 2012.
[28] Bassin EB, Wypij D, Davis RB, Mittleman MA. (2006). Age-specific Fluoride Exposure in Drinking Water & Osteosarcoma (United States). Cancer Causes & Control 17: 421-8.
[29] National Toxicology Program [NTP] (1990). Toxicology and Carcinogenesis Studies of Sodium Fluoride in F344/N Rats and B6C3f1 Mice. Technical report Series No. 393. NIH Publ. No 91-2848. National Institute of Environmental Health Sciences, Research Triangle Park, N.C.
[30] Yiamouyiannis (1993). Fluoridation and Cancer. The Biology and Epidemiology of Bone and Oral Cancer Related to Fluoridation. Fluoride, 26, 83-96.
[31] Yiamouyiannis J & Burk D (1977) Fluoridation and cancer: age-dependence of cancer mortality related to artificial fluoridation. Fluoride, 10, 102-123
[32] Burk D & Yiamouyiannis J (1975) Letter July 8, 1975, to Hon. James J Delaney. In Congressional Record, Proceedings and Debates of the 94th Congress. First Session. House of Representatives, July 21, 1975, 23729-23732
[33] National Toxicology Program (NTP) Tech Rep Ser. 1990 Dec;393:1-448. Toxicology and Carcinogenesis Studies of Sodium Fluoride (CAS No. 7681-49-4)in F344/N Rats and B6C3F1 Mice (Drinking Water Studies).
[34] J Epidemiol. 2001 Jul;11(4):170-9.Regression analysis of cancer incidence rates and water fluoride in the U.S.A. based on IACR/IARC (WHO) data (1978-1992). International Agency for Research on Cancer, by Takahashi K, Akiniwa K, Narita K.
[35] U.S National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C.
[36] Waugh. D. Human Toxicity, Environmental Impact and legal Implications of Water Fluoridation, Submitted to the government of Ireland March 2012, Pages 276-281.
[37] WHO. Fluorides and oral health. Technical Report Series-846. WHO,Geneva 1984.
[38] Zhavoronkov AA. Non-skeletal forms of fluorosis. Arch Pathol 1977; 39: 83-91.
[39] Choi AL, Sun G, Zhang Y, Grandjean P, 2012, Harvard School of Public Health, Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environ Health Perspect doi:10.1289/ehp.1104912
[40] Spittle B. 2011. Neurotoxic effects of fluoride. Fluoride 44(3):117-124.
[41] P Grandjean, PJ Landrigan, Developmental neurotoxicity of industrial chemicals,
The Lancet, Volume 368 November 8, 2006
[42] International Programme on Chemical Safety. (1984). Environmental Health Criteria 36: Fluorine and Fluorides. Geneva, Switzerland: World Health Organization.
[43] Choi AL, Sun G, Zhang Y, Grandjean P, 201 2 Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environmental Health Perspectives on July 20, 2012.
[44] Kauffman J. M. Ph.D. Water Fluoridation: A Review of Recent Research and Actions, Journal of American Physicians and Surgeons (Volume 10 Number 2 Summer 2005).


  1. Thank you Declan, I came across your blog and find it both fascinating and disturbing. Regards Ben O'Toole

  2. Thank you Declan you have opened my eyes to a very serious problem. I'm both fascinated and disturbed,
    Regards Ben